title: Combined biomarker testing for the prediction of left ventricular remodelling in ST-elevation myocardial infarction.
abstract: The utility of different biomarkers for the prediction of left ventricular remodelling (LVR) following ST-elevation myocardial infarction (STEMI) has been evaluated in several studies. However, very few data exist on the prognostic value of combined biomarkers. The aim of this study was to comprehensively investigate the prognostic value for LVR of routinely available biomarkers measured after reperfused STEMI.
  
  
  
  Serial measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and high-sensitivity C reactive protein (hs-CRP) were performed in 123 patients with STEMI treated with primary percutaneous coronary intervention in this prospective observational study. Patients underwent cardiac MRI at 2 (1-4) and 125 (121-146) days after infarction. An increase in end-diastolic volume of ≥20% was defined as LVR.
  
  
  
  LVR occurred in 16 (13%) patients. Peak concentrations of the following biomarkers showed significant areas under the curves (AUCs) for the prediction of LVR-NT-proBNP: 0.68 (95% CI 0.59 to 0.76, p=0.03), hs-cTnT: 0.75 (95% CI 0.66 to 0.82, p<0.01), AST: 0.72 (95% CI 0.63 to 0.79, p<0.01), ALT: 0.66 (95% CI 0.57 to 0.75, p=0.03), LDH: 0.78 (95% CI 0.70 to 0.85, p<0.01) and hs-CRP: 0.63 (95% CI 0.54 to 0.72, p=0.05). The combination of all biomarkers yielded a significant increase in AUC to 0.85 (95% CI 0.77 to 0.91) (all vs NT-proBNP: p=0.02, all vs hs-cTnT: p=0.02, all vs AST: p<0.01, all vs ALT: p<0.01, all vs hs-CRP: p<0.01 and all vs LDH: p=0.04).
  
  
  
  In patients with reperfused STEMI, the combined assessment of peak NT-proBNP, hs-cTnT, AST, ALT, hs-CRP and LDH provide incremental prognostic information for the prediction of LVR when compared with single-biomarker measurement.
authors.affiliation: Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Sebastian Johannes
authors.initials: SJ
authors.lastname: Reinstadler
authors.affiliation: Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Hans-Josef
authors.initials: HJ
authors.lastname: Feistritzer
authors.affiliation: Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Reindl
authors.affiliation: Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Gert
authors.initials: G
authors.lastname: Klug
authors.affiliation: Department of Radiology , Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mayr
authors.affiliation: Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mair
authors.affiliation: Department of Radiology , Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Jaschke
authors.affiliation: Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Metzler
keywords: ST-elevation myocardial infarction; biomarker; cardiac magnetic resonance imaging; left ventricular remodeling