title: Measurement of troponin and natriuretic peptides shortly after admission in patients with heart failure-does it add useful prognostic information? An analysis of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS).
abstract: Plasma concentrations of B-type natriuretic peptide (BNP) and troponin are often measured for diagnostic purposes when patients are admitted with heart failure, but their prognostic value when measured soon after admission is uncertain. We aimed to investigate the added prognostic value of admission measurements of BNP and troponins in patients with acute heart failure.
  
  
  
  Multivariable prognostic models for death or any worsening heart failure (WHF) or rehospitalization for WHF by 30 days, 30-day death or rehospitalization for WHF, and 90-day mortality were constructed using baseline data from the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (VERITAS) including BNP and troponin I. Of 1347 patients, the median (interquartile range) value of BNP was 422 (156-945) pg/mL and 855 (63%) had measurable troponin I. By 30 days, 432 patients had died or experienced WHF. Clinical variables had only moderate predictive performance that was not substantially improved by BNP or troponin I (c-indices 0.6528 and 0.6595, respectively). By 30 days, 150 patients died or were rehospitalized for WHF. The c-index using clinical variables (0.6855) was not improved by adding biomarkers. By 90 days, 135 patients had died. The c-index for mortality was somewhat better than for composite outcomes (0.7394) but improved little with biomarkers (0.7461).
  
  
  
  Routine clinical data recorded at the time of admission in patients with acute heart failure are poor at predicting recurrent admissions but somewhat better at predicting mortality. Neither BNP nor troponin measured at admission improved predictions; measurement closer to discharge, or of other novel biomarkers, might perform differently.
authors.affiliation: University of Hull, Kingston upon Hull, UK.|National Heart and Lung Institute, Royal Brompton and Harefield Hospitals NHS Trust, Imperial College, London, UK.
authors.forename: John G F
authors.initials: JGF
authors.lastname: Cleland
authors.affiliation: University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: Momentum Research, Inc., Durham, NC, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.affiliation: University of Hull, Kingston upon Hull, UK.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shoaib
authors.affiliation: University of Brescia, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Momentum Research, Inc., Durham, NC, USA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Senger
authors.affiliation: Momentum Research, Inc., Durham, NC, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Milo
authors.affiliation: Momentum Research, Inc., Durham, NC, USA.
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
authors.affiliation: Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: John D
authors.initials: JD
authors.lastname: Parker
authors.affiliation: Service de Cardiologie, Hôpital Bichat, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
authors.affiliation: Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Australia (deceased 28 November 2015).
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas, USA.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.affiliation: University Medical Centre, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: University of Glasgow, Glasgow, UK.
authors.forename: John J V
authors.initials: JJV
authors.lastname: McMurray
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010351:Patient Discharge / Q000639:trends; D011379:Prognosis; D011725:Pyridines / Q000008:administration & dosage*; D017466:Receptors, Endothelin / Q000097:blood / Q000187:drug effects*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013777:Tetrazoles / Q000008:administration & dosage*; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D011725:Pyridines; D017466:Receptors, Endothelin; D013777:Tetrazoles; D019210:Troponin I; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; C120582:tezosentan
keywords: Acute heart failure; Biomarkers; Prognosis; Statistical models