title: Serum biomarkers and clinical outcomes in heart failure patients treated de novo with carvedilol.
abstract: BACKGROUND
  The role of inflammatory and hemodynamic stress biomarkers in heart failure (HF) patients treated de novo with beta-blockers has been poorly studied.
  
  
  METHODS
  A total of 86 patients (age 56 ± 9 years, 81 men) with left ventricular ejection fraction (LVEF) < 40% and previously not treated with beta-blockers were initiated on carvedilol. At baseline and 12 months later we performed echocardiography, cardiopulmonary exercise testing, and determined serum levels of B-type natriuretic peptide (BNP), endothelin-1 (ET-1), C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNF -a). Patients were followed up over a total period of 9 ± 3 years from baseline.
  
  
  RESULTS
  Increased baseline CRP and its on-treatment decrease were associated with improvement of LVEF (est. coefficient per one SD: 1.6; 95% CI: -0.05,3.28; p = 0.056, and -1.80; -3.43, -0.18; p = 0.030, respectively) and diminishing of LV end-systolic volume index [mL/m2] (-6.83; -11.32; -2.34; p = 0.003, and 5.85; 1.23; -10.46; p = 0.014, respectively). Higher baseline ET-1 and on-treatment increase in TNF-a predicted frequent admissions (> 1) for cardiac complications (odds ratio per one SD: 1.98; 95% CI: 1.09-3.59; p = 0.025, and 2.07, 1.12-3.84, p = 0.021, respectively) whereas higher baseline BNP was associated with increased mortality (hazard ratio per one SD: 2.09, 95% CI: 1.26-3.45; p = 0.004).
  
  
  CONCLUSIONS
  Serum biomarkers may have different roles in prediction of clinical outcomes among HF patients treated de novo with carvedilol.
authors.affiliation: artur.fedorowski@med.lu.se.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Nessler
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nessler
authors.forename: Renata
authors.initials: R
authors.lastname: Golebiowska-Wiatrak
authors.forename: Ilona
authors.initials: I
authors.lastname: Palka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gackowski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kitlinski
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
authors.forename: Artur
authors.initials: A
authors.lastname: Fedorowski
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011044:Poland; D011412:Propanolamines / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D002227:Carbazoles; D019332:Endothelin-1; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D010446:Peptide Fragments; D011412:Propanolamines; D014409:Tumor Necrosis Factor-alpha; C109794:pro-brain natriuretic peptide (1-76); D000077261:Carvedilol; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein