on July 29, 2009
Published online before print July 29, 2009, doi: 10.1161/CIRCHEARTFAILURE.109.849299
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Original Article |
Prognostic Value of Biomarkers in Heart Failure: Application of Novel Methods in the Community
1 Mayo Clinic, Rochester, MN;
2 Mayo Clinic, Rochester, MN; Tel Aviv University, Tel Aviv, Israel
* Corresponding author; email: roger.veronique{at}mayo.edu
Background—Mortality among patients with heart failure (HF) is high. Though individual biomarkers have been investigated to determine their value in mortality risk prediction, the role of a multimarker strategy requires further evaluation.
Methods and Results—Olmsted County residents presenting with HF from July 2004 to September 2007 were recruited to undergo biomarker measurement. We investigated whether addition of C-reactive protein (CRP), B-type natriuretic peptide (BNP), and troponin T (TnT) to a model including established risk indicators improved 1-year mortality risk prediction using the c statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Among 593 participants, the mean age was 76.4 years and 48% were men. After 1 year follow-up, 122 (20.6%) participants had died. Patients with CRP (<11.8mg/L), BNP (<350pg/mL), and TnT (
0.01ng/mL) below the median had low 1-year mortality (3.3%), while those with two or three biomarkers above the median had markedly increased mortality (30.8% and 35.5%, respectively). The addition of two or more biomarkers to the model offered greater improvement in 1-year mortality risk prediction than use of a single biomarker. The combination of CRP and BNP resulted in an increase in the c statistic from 0.757 to 0.810 (p<0.001), an IDI gain of 7.1% (p<0.001), and a NRI of 22.1% (p<0.001). Use of all three biomarkers offered no incremental gain (IDI gain 0.7% vs. CRP+BNP, p=0.065).
Conclusions—Biomarkers improved 1-year mortality risk prediction beyond established indicators. The use of a two-biomarker combination was superior to a single biomarker in risk prediction, though addition of a third biomarker conferred no added benefit.
Key Words: epidemiology • heart failure • inflammation • prognosis • community
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