Multiple Cardiac Biomarker Testing Among Patients With Acute Dyspnea From the ICON-RELOADED Study.

Area of Science:

• Cardiology
• Biomarker research
• Emergency medicine

Background:

• Acute dyspnea is a common emergency department presentation.
• Biomarkers like NT-proBNP, hsTnT, and IGFBP7 are known to predict cardiovascular outcomes.
• Optimal interpretation of these biomarkers in acute dyspnea remains unclear.

Purpose of the Study:

• To investigate the diagnostic and prognostic value of a multimarker panel in patients with acute dyspnea.
• To determine if the number of elevated biomarkers can improve risk stratification for mortality and heart failure rehospitalization.

Main Methods:

• Analysis of NT-proBNP, hsTnT, and IGFBP7 concentrations in 1448 patients with acute dyspnea from the ICON-RELOADED study.
• Biogroup derivation based on biomarker elevation patterns.
• Comparison of biogroups for baseline characteristics, acute heart failure (HF) diagnosis, and 180-day mortality or HF rehospitalization.

Main Results:

• Among patients with all three biomarkers elevated, 49.4% were diagnosed with acute HF.
• The frequency of acute HF diagnosis increased significantly with the number of elevated biomarkers.
• Elevations in one, two, or three biomarkers were associated with 3.74, 12.3, and 12.6 fold increased risk of 180-day mortality or HF rehospitalization, respectively.

Conclusions:

• A multimarker panel including NT-proBNP, hsTnT, and IGFBP7 offers valuable clinical, diagnostic, and prognostic information in acute dyspnea.
• The number of elevated biomarkers at presentation allows for efficient clinical risk stratification of short-term mortality and HF rehospitalization.