Abstract
Cardiac myosin-binding protein C (cMyC) seems to be even more sensitive in the quantification of cardiomyocyte injury vs. high-sensitivity cardiac troponin, and may therefore have diagnostic and prognostic utility. In a prospective multicentre diagnostic study, cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations were measured in blinded fashion in patients presenting to the emergency department with acute dyspnoea. Two independent cardiologists centrally adjudicated the final diagnosis. Diagnostic accuracy for acute heart failure (AHF) was quantified by the area under the receiver operating characteristic curve (AUC). All-cause mortality within 360 days was the prognostic endpoint. Among 1083 patients eligible for diagnostic analysis, 51% had AHF. cMyC concentrations at presentation were higher among AHF patients vs. patients with other final diagnoses [72 (interquartile range, IQR 39-156) vs. 22 ng/L (IQR 12-42), P < 0.001)]. cMyC's AUC was high [0.81, 95% confidence interval (CI) 0.78-0.83], higher than hs-cTnT's (0.79, 95% CI 0.76-0.82, P =0.081) and lower than NT-proBNP's (0.91, 95% CI 0.89-0.93, P < 0.001). Among 794 AHF patients eligible for prognostic analysis, 28% died within 360 days; cMyC plasma concentrations above the median indicated increased risk of death (hazard ratio 2.19, 95% CI 1.66-2.89; P < 0.001). cMyC's prognostic accuracy was comparable with NT-proBNP's and hs-cTnT's. cMyC did not independently predict all-cause mortality when used in validated multivariable regression models. In novel multivariable regression models including medication, age, left ventricular ejection fraction, and discharge creatinine, cMyC remained an independent predictor of death and had no interactions with medical therapies at discharge. Cardiac myosin-binding protein C may aid physicians in the rapid triage of patients with suspected AHF.
Highlights
Acute heart failure (AHF) is the most common diagnosis in the emergency department (ED) leading to hospitalization.[1,2] In contrast to the enormous improvements achieved in the management of patients with chronic heart failure, morbidity and mortality remain unacceptably high in patients with AHF
Among the different AHF phenotypes, acute coronary syndrome with AHF, and pulmonary oedema were associated with even higher Cardiac myosin-binding protein C (cMyC) concentrations. cMyC plasma concentrations showed a strong correlation with high-sensitivity cardiac troponin T (hs-cTnT) (0.792, P < 0.001) and NT-proBNP (0.691, P < 0.001) concentrations, and a modest correlation with cardiac structure and function as quantified by left ventricular ejection fraction (LVEF) (−0.320, all P < 0.001; online supplementary Table S3)
After multivariable adjustment including age, LVEF, and creatinine plasma concentrations at discharge, the interactions regarding cMyC plasma concentrations lost their statistical significance. This secondary analysis within a large prospective diagnostic study aimed to evaluate the clinical utility of cMyC in the diagnosis, risk stratification and therapy guidance of patients with AHF.[1,2]
Summary
Acute heart failure (AHF) is the most common diagnosis in the emergency department (ED) leading to hospitalization.[1,2] In contrast to the enormous improvements achieved in the management of patients with chronic heart failure, morbidity and mortality remain unacceptably high in patients with AHF. As quantitative markers of haemodynamic stress and heart failure, natriuretic peptides have substantially improved the rapid detection of AHF among patients presenting with acute dyspnoea.[1,2,5,6,7,8] Second, high-sensitivity cardiac troponin (hs-cTn) concentrations allow quantification of cardiomyocyte injury and enhance risk stratification of AHF patients.[6,9,10]
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