Combined biomarker testing for the prediction of left ventricular remodelling in ST-elevation myocardial infarction
Sebastian Johannes Reinstadler1, Hans-Josef Feistritzer1, Martin Reindl1
1Department of Cardiology and Angiology , University Clinic of Internal Medicine III, Medical University of Innsbruck , Innsbruck , Austria.
Insights
Combining multiple biomarkers like NT-proBNP, hs-cTnT, AST, ALT, LDH, and hs-CRP significantly improves the prediction of left ventricular remodelling (LVR) after ST-elevation myocardial infarction (STEMI). This comprehensive approach offers better prognostic information than single biomarker assessments.
Area of Science:
- Cardiology
- Biomarker Research
- Medical Diagnostics
Background:
- Left ventricular remodelling (LVR) is a critical complication following ST-elevation myocardial infarction (STEMI).
- Predictive models for LVR often rely on single biomarkers, with limited data on the prognostic value of combined markers.
- Routine biomarkers measured post-STEMI require comprehensive evaluation for their combined predictive utility.
Purpose of the Study:
- To investigate the prognostic value of routinely available biomarkers for predicting LVR after reperfused STEMI.
- To assess the incremental prognostic information provided by a combination of biomarkers compared to individual measurements.
Main Methods:
- A prospective observational study involving 123 patients with STEMI treated with primary percutaneous coronary intervention.
- Serial measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and high-sensitivity C-reactive protein (hs-CRP).
- Cardiac MRI was performed at 2 and 125 days post-infarction to define LVR (≥20% increase in end-diastolic volume).
Main Results:
- LVR occurred in 13% of patients.
- Peak concentrations of individual biomarkers (NT-proBNP, hs-cTnT, AST, ALT, LDH, hs-CRP) showed significant predictive capability for LVR.
- The combination of all assessed biomarkers significantly increased the area under the curve (AUC) for LVR prediction to 0.85, outperforming single biomarker assessments.
Conclusions:
- Combined assessment of peak NT-proBNP, hs-cTnT, AST, ALT, hs-CRP, and LDH provides incremental prognostic information for LVR prediction in reperfused STEMI patients.
- This multi-biomarker strategy enhances the prediction of LVR compared to relying on single biomarker measurements.
- Routine biomarkers, when assessed collectively, offer a powerful tool for risk stratification in STEMI patients.
Objective:
The utility of different biomarkers for the prediction of left ventricular remodelling (LVR) following ST-elevation myocardial infarction (STEMI) has been evaluated in several studies. However, very few data exist on the prognostic value of combined biomarkers. The aim of this study was to comprehensively investigate the prognostic value for LVR of routinely available biomarkers measured after reperfused STEMI.
Methods:
Serial measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and high-sensitivity C reactive protein (hs-CRP) were performed in 123 patients with STEMI treated with primary percutaneous coronary intervention in this prospective observational study. Patients underwent cardiac MRI at 2 (1-4) and 125 (121-146) days after infarction. An increase in end-diastolic volume of ≥20% was defined as LVR.
Results:
LVR occurred in 16 (13%) patients. Peak concentrations of the following biomarkers showed significant areas under the curves (AUCs) for the prediction of LVR-NT-proBNP: 0.68 (95% CI 0.59 to 0.76, p=0.03), hs-cTnT: 0.75 (95% CI 0.66 to 0.82, p<0.01), AST: 0.72 (95% CI 0.63 to 0.79, p<0.01), ALT: 0.66 (95% CI 0.57 to 0.75, p=0.03), LDH: 0.78 (95% CI 0.70 to 0.85, p<0.01) and hs-CRP: 0.63 (95% CI 0.54 to 0.72, p=0.05). The combination of all biomarkers yielded a significant increase in AUC to 0.85 (95% CI 0.77 to 0.91) (all vs NT-proBNP: p=0.02, all vs hs-cTnT: p=0.02, all vs AST: p<0.01, all vs ALT: p<0.01, all vs hs-CRP: p<0.01 and all vs LDH: p=0.04).
Conclusions:
In patients with reperfused STEMI, the combined assessment of peak NT-proBNP, hs-cTnT, AST, ALT, hs-CRP and LDH provide incremental prognostic information for the prediction of LVR when compared with single-biomarker measurement.
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