title: Measurement of multiple biomarkers in advanced stage heart failure patients treated with pulmonary artery catheter guided therapy.
abstract: BACKGROUND
  This study was carried out to investigate the prognostic utility of biomarkers in advanced stage heart failure (HF) patients requiring ICU admission for pulmonary artery catheter (PAC) guided therapy.
  
  
  METHODS
  Thirty patients admitted to an ICU for PAC guided HF therapy were enrolled; concentrations of soluble ST2 (sST2), highly sensitive troponin I, an experimental ultrasensitive troponin I, amino-terminal pro-B type natriuretic peptide, cystatin C, and myeloperoxidase were measured over the first 48 hours. Outcomes included response of filling pressures and hemodynamics to tailored therapy and 90-day event-free survival (death, left ventricular assist device implantation, transplant).
  
  
  RESULTS
  Of the biomarkers evaluated, only sST2 concentrations were higher in those who failed to achieve goals for central venous pressure ((CVP), 225.3 versus 104.6 ng/mL; P = 0.003) and pulmonary capillary wedge pressure ((PCWP), 181.7 versus 88.2 ng/mL; P = 0.05). Only sST2 concentrations were associated with adverse events (186.7 versus 92.2 ng/mL; P = 0.01). In age-adjusted Cox proportional hazards analysis, an elevated sST2 during the first 48 hours following ICU admission independently predicted 90-day outcomes (Hazard Ratio = 5.53; P = 0.03) superior to the Simplified Acute Physiology Score for this application; in Kaplan-Meier analysis the risk associated with elevated sST2 concentrations was present early and sustained through the duration of follow-up (log rank P = 0.01).
  
  
  CONCLUSIONS
  In patients undergoing HF therapy guided by invasive monitoring, sST2 concentrations were associated with impending failure to reduce filling pressures and predicted impending events. Elevated sST2 values early in the ICU course theoretically could assist therapeutic decision-making in advanced stage HF patients.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00595738.
authors: Jodi L
authors: JL
authors: Zilinski
authors: Ravi V
authors: RV
authors: Shah
authors: Hanna K
authors: HK
authors: Gaggin
authors: Mary Lou
authors: ML
authors: Gantzer
authors: Thomas J
authors: TJ
authors: Wang
authors: James L
authors: JL
authors: Januzzi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D006328:Cardiac Catheterization / Q000379:methods*; D055316:Cystatin C / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D009195:Peroxidase / Q000097:blood; D011379:Prognosis; D011651:Pulmonary Artery; D011956:Receptors, Cell Surface / Q000097:blood; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D055316:Cystatin C; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D010446:Peptide Fragments; D011956:Receptors, Cell Surface; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009195:Peroxidase