title: Cardiotrophin-1 predicts death or heart failure following acute myocardial infarction.
abstract: BACKGROUND
  Cardiotrophin-1 (CT-1) is an important inflammatory cytokine; its presence has been documented in patients after acute myocardial infarction (AMI). However, its role as a predictor of death or heart failure is unclear. We sought to investigate this and compared it with N terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of death or heart failure.
  
  
  RESULTS
  We studied 291 post-AMI patients. The plasma concentration of CT-1 and NT-proBNP was determined using in-house noncompetitive immunoassays and patients followed for death or heart failure. There were 27 deaths and 19 readmissions with heart failure. CT-1 was raised in patients with death or heart failure compared with survivors (median [range] fmol/mL, 0.9 [0.1-392.2] vs. 0.67 [0-453.3], P = .019). Using a multivariate binary logistic model CT-1 (OR 1.8, 95% CI: 1.1-3.2, P = .031) and NT-proBNP (OR 2.4, 95% CI: 1.1-5.2, P = .026) predicted death or heart failure independently of age, sex, previous AMI, serum creatinine, and Killip class. The receiver-operating curve for CT-1 yielded an area under the curve (AUC) of 0.62 (95% CI: 0.53-0.70, P = .017); for NT-proBNP the AUC was 0.77 (95% CI: 0.69-0.86, P < .001); the logistic model combining the 2 markers yielded an AUC of 0.84 (95% CI: 0.78-0.91, P < .001).
  
  
  CONCLUSIONS
  After an AMI, combined levels of CT-1 and NT-proBNP are more informative at predicting death or heart failure than either marker alone.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: Sohail Q
authors.initials: SQ
authors.lastname: Khan
authors.forename: Dominic
authors.initials: D
authors.lastname: Kelly
authors.forename: Paulene
authors.initials: P
authors.lastname: Quinn
authors.forename: Joan E
authors.initials: JE
authors.lastname: Davies
authors.forename: Leong L
authors.initials: LL
authors.lastname: Ng
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000209:etiology*; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D012372:ROC Curve; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D016207:Cytokines; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; C092073:cardiotrophin 1