title: Biomarker changes during acute heart failure treatment.
abstract: Biomarker changes may provide physicians with objective evidence of treatment efficacy in patients with acute decompensated heart failure (ADHF) and facilitate early hospital discharge. The authors hypothesize that mid-regional-pro-adrenomedullin (MR-proADM), C-terminal-pro-endothelin-1 (CT-pro-ET-1), and mid-regional-pro-atrial natriuretic peptide (MR-proANP) change during the first 24 hours of ADHF therapy. Eligible patients had an emergency department diagnosis of ADHF and fulfilled modified Framingham criteria. Clinical data, serum, and plasma values were collected at enrollment, 2 to 4 hours, and 12 to 24 hours after treatment. Changes in biomarker concentrations from baseline to 2 to 4 hours, baseline to 12 to 24 hours, and 2 to 4 to 12 to 24 hours were calculated. Fisher exact and Kruskal-Wallis tests were used for comparisons. Forty-eight patients were included. The median age was 62 years (range 40-88), 54% were men and 50% were white. More patients had changes in MR-pro-ANP levels in the first 2 to 4 hours after ADHF therapy compared with MR-proADM or CT-pro-ET-1 (36% vs 16% and 24%). However, 12 to 24 hours after therapy, similar proportions of patients had changes in MR-proANP, MR-proADM, and CT-proET-1 levels (47%, 41%, and 49%). In this preliminary study, patients with ADHF had measurable changes in MR-proANP, MR-proADM, and CT-pro-ET-1 24 hours after initial therapy. A study of association with clinical course and outcomes to determine the role of these markers in risk-stratification is warranted.
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Boyer
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Sperling
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D016009:Chi-Square Distribution; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; C557077:C-terminal proendothelin-1; D019332:Endothelin-1; D010446:Peptide Fragments; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor