title: Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure.
abstract: OBJECTIVE
  To investigate the use of biomarkers providing independent information regarding physiology in acutely decompensated heart failure (ADHF) for assessment of risk.
  
  
  RESULTS
  This was a prospective study of 107 patients hospitalized with ADHF (mean age 72 ± 13 years, 44% male, left ventricular ejection fraction 47 ± 15%). Blood samples were collected on presentation to measure soluble (s)ST2, high-sensitivity troponin T (hsTnT), and amino-terminal pro-B type natriuretic peptide (NT-proBNP) levels. Clinical follow-up was obtained for all patients over a median period of 739 days, and all-cause mortality was registered. Concentrations of sST2 [per 10 ng/mL, hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.04-1.13; P< 0.001], hsTnT (per 0.1 ng/mL, HR 1.16, 95% CI 1.09-1.24; P< 0.001), and NT-proBNP (per 100 pg/mL, HR 1.01, 95% CI 1.003-1.01; P< 0.001) were each predictive of a higher risk of death. In bootstrapped models, each biomarker retained independent predictive value for mortality. Patients with all three biomarkers below their optimal cut-off at presentation were free of death (0%) during follow-up, whereas 53% of those with elevations of all three biomarkers had died. For each elevated marker (from 0 to 3) adjusted analysis suggested a tripling of the risk of death (for each elevated marker, HR 2.64, 95% CI 1.63-4.28, P< 0.001). Integrated discrimination analyses indicated that the use of these three markers in a multimarker approach uniquely improved prediction of death.
  
  
  CONCLUSIONS
  Biomarkers reflecting remodelling (sST2), myonecrosis (hsTnT), and myocardial stretch (NT-proBNP) provide complementary prognostic information in patients with ADHF. When used together, these novel markers provide superior risk stratification.
authors.affiliation: Cardiology Department, Virgen de la Arrixaca Hospital and School of Medicine, University of Murcia, Murcia, Spain. dapascual@servicam.com
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual-Figal
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
authors.forename: Miguel
authors.initials: M
authors.lastname: Boronat
authors.forename: Teresa
authors.initials: T
authors.lastname: Casas
authors.forename: Iris P
authors.initials: IP
authors.lastname: Garrido
authors.forename: Juan C
authors.initials: JC
authors.lastname: Bonaque
authors.forename: Francisco
authors.initials: F
authors.lastname: Pastor-Perez
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011956:Receptors, Cell Surface / Q000097:blood*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D020107:Troponin T / Q000097:blood*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011956:Receptors, Cell Surface; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain