title: Response of novel biomarkers to BNP infusion in patients with decompensated heart failure: a multimarker paradigm.
abstract: Multibiomarker paradigms have been proposed to diagnose, define progression, and to monitor therapy of heart failure (HF) patients. The aim of this study was to evaluate the prognostic and therapy-monitoring potential of four novel biomarkers (copeptin, midregional proatrial natriuretic peptide (MR-proANP), neopterin, and procalcitonin) which have been shown to be elevated in the plasma of patients with HF and reported to have prognostic value. In a prospective study of 40 patients hospitalized for decompensated HF and who received nesiritide infusions as part of their care, blood was drawn before, during, and postinfusion and assayed for the novel biomarkers. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) which were previously measured and reported in this cohort were also included in the analyses. All biomarkers were elevated at baseline prior to nesiritide infusion, but copeptin, MR-proANP, and NT-proBNP demonstrated significant acute reductions in plasma levels in response to therapy. Copeptin levels were higher in posthospital nonsurvivors and by proportional hazards model were associated with an increased mortality risk (p = 0.04). Procalcitonin and neopterin added no incremental information on response to therapy or risk stratification. In contrast, copeptin and MR-proANP appear to have potential for monitoring acute responses to therapy. Only copeptin and BNP contributed to risk stratification in this cohort of advanced HF patients, but the conjoint use of BNP or NT-proBNP does not appear to impact the prognostic value of copeptin alone. These results are hypothesis generating to stimulate additional investigation.
authors.affiliation: Mayo Clinic, Rochester, MN 55905, USA. miller.wayne@mayo.edu
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Miller
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hartman
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Stacy
authors.initials: S
authors.lastname: Hartman
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016903:Drug Monitoring; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D008910:Minnesota; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage* / Q000097:blood; D019798:Neopterin / Q000097:blood; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D002317:Cardiovascular Agents; D006020:Glycopeptides; D011498:Protein Precursors; C048197:copeptins; D020097:Natriuretic Peptide, Brain; D019798:Neopterin; D009320:Atrial Natriuretic Factor; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide