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Heart failure biomarkers in patients with dilated cardiomyopathy
Agata Bielecka-Dabrowa1, Stephan von Haehling, Wilbert S Aronow
1Department of Hypertension, Medical University of Lodz, Poland.
Insights
Biomarkers like cystatin C (CysC) and N-terminal pro-brain natriuretic peptide (NT-proBNP) predict left ventricular ejection fraction (LVEF) increase in dilated cardiomyopathy (DCM). The 6-minute walk test (6MWT) predicts re-hospitalization, while NT-proBNP and LV diameter predict mortality.
Area of Science:
- Cardiology
- Biomarker Discovery
- Heart Failure Research
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Identifying reliable biomarkers for DCM progression and outcomes is crucial.
- Current management strategies require optimization through advanced diagnostic tools.
Purpose of the Study:
- To evaluate the clinical utility of selected heart failure biomarkers in patients with DCM.
- To assess the predictive value of biomarkers for left ventricular remodeling and functional capacity.
- To determine the association of biomarkers with re-hospitalization and mortality in DCM.
Main Methods:
- Prospective, randomized study of 68 DCM patients with left ventricular ejection fraction (LVEF) ≤ 40%.
- 5-year follow-up including clinical examination, biomarker measurement (TNF-α, IL-6, IL-10, syndecan-4, cystatin C (CysC), NT-proBNP), echocardiography, and 6-minute walk test (6MWT).
- Analysis of 45 patients, correlating biomarker levels with LVEF, ventricular dimensions, kidney function, exercise capacity, re-hospitalization, and mortality.
Main Results:
- Syndecan-4 correlated negatively with LVEF and positively with left ventricular (LV) dimensions.
- Cystatin C (CysC) correlated with right ventricular diameter, impaired kidney function, reduced LVEF, and decreased 6MWT performance.
- Lower CysC and NT-proBNP levels predicted LVEF increase; CysC ≤ 95 mg/l and NT-proBNP ≤ 32 pg/ml were optimal predictors.
- 6MWT was the sole independent predictor of HF re-hospitalization.
- NT-proBNP and LV diastolic diameter were independent risk factors for mortality.
Conclusions:
- Cystatin C (CysC) is a valuable biomarker reflecting impaired kidney function and reduced exercise capacity in DCM.
- Syndecan-4 shows potential as a biomarker for predicting adverse LV remodeling in DCM patients.
- NT-proBNP and LV diastolic diameter are critical indicators of mortality risk in DCM.
Background:
We set out to evaluate the utility of selected heart failure (HF) biomarkers in patients with dilated cardiomyopathy (DCM).
Methods:
In a prospective, randomized study, 68 DCM patients with left ventricular ejection fraction (LVEF) ≤ 40% treated optimally were included. They were observed for 5 years. Initial and control tests included full clinical examination, measurement of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and IL-10, syndecan-4, cystatin C (CysC) and N-terminal pro-brain natriuretic peptide (NT-proBNP), echocardiographic examination, and the assessment of exercise capacity in 6-minute walk test (6MWT).
Results:
Finally, after 5-year follow-up we analyzed the data of 45 DCM patients. Concentration of syndecan-4 correlated negatively with LVEF (R=-0.36, p=0.02) and positively with LV systolic (R=0.57, p<0.001) and diastolic diameters (R=0.64, p<0.001). A positive correlation between CysC and right ventricular diastolic diameter (R=0.38, p=0.01), and negative correlations between CysC and glomerular filtration rate (R=-0.49, p<0.001), LVEF (R=-0.4, p=0.02), and 6 MWT (R=-0.46, p<0.001) were noted. Patients who had an increase in LVEF during 5 years were characterized by lower levels of CysC (p=0.01) and NT-proBNP (p<0.001). CysC≤95mg/l and NT-proBNP≤32pg/ml were the best predictors of LVEF increase in DCM patients. Multivariate regression analysis showed that 6 MWT was the only independent predictor of HF re-hospitalization (OR 0.989; p<0.001), and NT-proBNP and LV diastolic diameter were the only risk factors of increased mortality (OR 1.001; p=0.007 and OR 2.960; p=0.025, respectively) in DCM patients.
Conclusions:
CysC correlates negatively with both kidney function and exercise capacity. Syndecan-4 may be a useful biomarker for predicting adverse LV remodeling in DCM patients.
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