Natriuretic peptides and E-selectin as predictors of acute deterioration in patients with inotrope-dependent heart failure.
OBJECTIVE
In patients with inotrope-dependent end-stage heart failure the timely application of the most suitable treatment, i.e. heart transplantation, implantation of a ventricular assist device or conservative treatment, is a key issue for therapeutic success.


METHODS
Seventy-six inotrope-dependent patients with end-stage heart failure were enrolled. Measurements of hemodynamics, routine laboratory parameters, and clinical examination were performed daily. Additionally, natriuretic peptides (BNP and NT-proBNP) and E-selectin were measured at the end of the study. The patients were retrospectively divided into groups with regard to the following end-points: Group I-deterioration into cardiogenic shock after an initially stable clinical course (n=26); Group II-stable clinical course without deterioration into cardiogenic (n=41); Group III-weaning from inotropic support (n=9).


RESULTS
One day before cardiogenic shock occurred, BNP, NT-proBNP and E-selectin were significantly elevated in group I compared with group II. A logistic regression model showed that only BNP and E-selectin were independent predictors of clinical deterioration on the following day. The odds ratio (OR) for E-selectin using a cut-off point of 65ng/ml was 8.7 and for BNP using a cut-off of 500pg/ml it was 4.8. In combination, the OR increased to 11.1. Continuous decrease of NT-proBNP predicted patients in whom weaning from inotropes was possible.


CONCLUSIONS
While routine parameters did not predict the clinical course, elevated BNP and E-selectin independently predicted cardiogenic shock on admission and 1 day before its occurrence. The combination showed increased predictive value.
Potapov
Evgenij V
EV
Deutsches Herzzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany. potapov@dhzb.de <potapov@dhzb.de>
Hennig
Felix
F
Wagner
Frank D
FD
Volk
Hans-Dieter
HD
Sodian
Ralf
R
Hausmann
Harald
H
Lehmkuhl
Hans B
HB
Hetzer
Roland
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019040:E-Selectin / Q000097:blood*; D017335:Enoximone / Q000008:administration & dosage / Q000627:therapeutic use; D004812:Epidemiologic Methods; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood*; D009419:Nerve Tissue Proteins / Q000097:blood; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000097:blood / Q000188:drug therapy
D015415:Biomarkers; D019040:E-Selectin; D045265:Natriuretic Peptides; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D002097:C-Reactive Protein; D017335:Enoximone; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine