Abstract
We assessed the predictive ability of selected biomarkers using N-terminal pro-brain natriuretic peptide (NT-proBNP) as the benchmark and tried to establish a multi-biomarker approach to heart failure (HF) in hypertensive patients. In 120 hypertensive patients with or without overt heart failure, the incremental predictive value of the following biomarkers was investigated: Collagen III N-terminal propeptide (PIIINP), cystatin C (CysC), lipocalin-2/NGAL, syndecan-4, tumor necrosis factor-α (TNF-α), interleukin 1 receptor type I (IL1R1), galectin-3, cardiotrophin-1 (CT-1), transforming growth factor β (TGF-β) and N-terminal pro-brain natriuretic peptide (NT-proBNP). The highest discriminative value for HF was observed for NT-proBNP (area under the receiver operating characteristic curve (AUC) = 0.873) and TGF-β (AUC = 0.878). On the basis of ROC curve analysis we found that CT-1 > 152 pg/mL, TGF-β < 7.7 ng/mL, syndecan > 2.3 ng/mL, NT-proBNP > 332.5 pg/mL, CysC > 1 mg/L and NGAL > 39.9 ng/mL were significant predictors of overt HF. There was only a small improvement in predictive ability of the multi-biomarker panel including the four biomarkers with the best performance in the detection of HF—NT-proBNP, TGF-β, CT-1, CysC—compared to the panel with NT-proBNP, TGF-β and CT-1 only. Biomarkers with different pathophysiological backgrounds (NT-proBNP, TGF-β, CT-1, CysC) give additive prognostic value for incident HF in hypertensive patients compared to NT-proBNP alone.
Highlights
Hypertension is a major contributor to the development of heart failure (HF)
Changes in the heart in hypertension have been investigated for many years, and we already know a lot about the remodeling that occurs in the heart, the coronary arteries and small capillaries delivering blood to the heart
In this study we investigated in patients with hypertension the diagnostic and prognostic multi-marker approach towards heart failure using selected biomarkers and using NT-proBNP as the benchmark
Summary
Hypertension is a major contributor to the development of heart failure (HF). We are aware of the fact that the pathophysiologic relationship between hypertension and heart failure is more complex than the development of left ventricular hypertrophy. A growing array of biological pathways support the syndrome we recognize as heart failure. These include deleterious pathways promoting heart failure development and progression, as well as compensatory cardioprotective pathways. Components of these pathways can be utilized as biomarkers of this condition in order to facilitate the diagnosis and prognostication and potentially direct the management [1]
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