ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study
Adriana Chetran1,2, Alexandru Dan Costache1,3, Carmen Iulia Ciongradi4,5
1Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
Insights
Electrocardiogram (ECG) parameters correlate with cardiac biomarkers in acute heart failure (AHF) patients. This finding supports ECG
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Tools
Background:
- Acute heart failure (AHF) diagnosis relies on accessible investigations like biomarkers and electrocardiograms (ECG).
- Combining ECG and biomarker data may enhance predictive models for AHF management.
- Investigating correlations between specific ECG parameters and cardiac biomarkers in AHF is crucial.
Purpose of the Study:
- To identify ECG parameters correlated with cardiac biomarkers in Romanian patients with AHF.
- To explore the potential of combined ECG and biomarker analysis for improved AHF diagnosis and prognosis.
Main Methods:
- Prospective case-control study involving 49 AHF patients and 31 controls.
- Measurement of prohormone N-terminal proBNP (NT-proBNP), high-sensitive cardiac troponin I (hs-cTnI), and CK-MB.
- 12-lead ECG and 24-hour Holter monitoring were performed on all participants.
Main Results:
- Significantly higher NT-proBNP levels were observed in AHF patients (p < 0.001).
- NT-proBNP correlated with cQTi, pathological Q wave, complex premature ventricular contractions (PVCs), and ventricular tachycardia.
- Hs-cTnI and CK-MB correlated with ST-segment modification; hs-cTnI also correlated with complex PVCs.
Conclusions:
- Statistical relationships between cardiac biomarkers and ECG patterns confirm ECG's added value in AHF diagnosis.
- Subtle ECG parameters, often missed, are important for AHF assessment.
- ECG serves as a non-invasive warning signal for acute decompensation and complements biomarker data for diagnosing AHF, especially in cases of uncertain dyspnea etiology.
Abstract:
Background: Biomarkers, electrocardiogram (ECG) and Holter ECG are basic, accessible and feasible cardiac investigations. The combination of their results may lead to a more complex predictive model that may improve the clinical approach in acute heart failure (AHF). The main objective was to investigate which ECG parameters are correlated with the usual cardiac biomarkers (prohormone N-terminal proBNP, high-sensitive cardiac troponin I) in patients with acute heart failure, in a population from Romania. The relationship between certain ECG parameters and cardiac biomarkers may support future research on their combined prognostic value. Methods: In this prospective case-control study were included 49 patients with acute heart failure and 31 participants in the control group. For all patients we measured levels of prohormone N-terminal proBNP (NT-proBNP), high-sensitive cardiac troponin I (hs-cTnI) and MB isoenzyme of creatine phosphokinase (CK-MB) and evaluated the 12-lead ECG and 24 h Holter monitoring. Complete clinical and paraclinical evaluation was performed. Results: NT-proBNP level was significantly higher in patients with AHF (p < 0.001). In patients with AHF, NT-proBNP correlated with cQTi (p = 0.027), pathological Q wave (p = 0.029), complex premature ventricular contractions (PVCs) (p = 0.034) and ventricular tachycardia (p = 0.048). Hs-cTnI and CK-MB were correlated with ST-segment modification (p = 0.038; p = 0.018) and hs-cTnI alone with complex PVCs (p = 0.031). Conclusions: The statistical relationships found between cardiac biomarkers and ECG patterns support the added value of ECG in the diagnosis of AHF. We emphasize the importance of proper ECG analysis of more subtle parameters that can easily be missed. As a non-invasive technique, ECG can be used in the outpatient setting as a warning signal, announcing the acute decompensation of HF. In addition, the information provided by the ECG complements the biomarker results, supporting the diagnosis of AHF in cases of dyspnea of uncertain etiology. Further studies are needed to confirm long-term prognosis in a multi-marker approach.
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