Multiple Cardiac Biomarker Testing Among Patients with Acute Dyspnea from the ICON-RELOADED Study
Gaggin, Hanna K
Ibrahim, Nasrien E
Chen-Tournoux, Annabel A
Christenson, Robert H
Hollander, Judd E
Levy, Phillip D
Nagurney, John T
Nowak, Richard M
Pang, Peter S
Peacock, W Franklin
Walters, Elizabeth L
Januzzi, James L
JournalJournal of Cardiac Failure
MetadataShow full item record
AbstractBackground: Among patients with acute dyspnea, concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) and insulin-like growth factor binding protein-7 (IGFBP7) predict cardiovascular outcomes and death. Understanding the optimal means to interpret these elevated biomarkers in patients presenting with acute dyspnea remains unknown. Methods and results: Concentrations of NT-proBNP, hs-cTnT, and IGFBP7 were analyzed in 1,448 patients presenting with acute dyspnea from the prospective, multicenter ICON-RELOADED (International Collaborative of NT-proBNP-Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department) Study. Eight biogroups were derived based upon patterns in biomarker elevation at presentation and compared for differences in baseline characteristics. Of 441 patients with elevations in all three biomarkers, 218 (49.4%) were diagnosed with acute heart failure (HF). The frequency of acute HF diagnosis in this biogroup was higher than those with elevations in two biomarkers (18.8%, 44 out of 234), one biomarker (3.8%, 10 out of 260), or no elevated biomarkers (0.4%, 2 out of 513). The absolute number of elevated biomarkers on admission was prognostic of the composite endpoint of mortality and HF rehospitalization. In adjusted models, patients with one, two, and three elevated biomarkers had 3.74 (95% CI, 1.26-11.1; P=0.017), 12.3 (95% CI, 4.60-32.9; P <0.001), and 12.6 (95% CI, 4.54-35.0; P <0.001) fold increased risk of 180-day mortality or HF rehospitalization. Conclusions: A multimarker panel of NT-proBNP, hsTnT, and IGBFP7 provides unique clinical, diagnostic and prognostic information in patients presenting with acute dyspnea. Differences in the number of elevated biomarkers at presentation may allow for more efficient clinical risk stratification of short-term mortality and HF rehospitalization.
Rights/TermsCopyright © 2021. Published by Elsevier Inc.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/17063
- Rationale and design of the ICON-RELOADED study: International Collaborative of N-terminal pro-B-type Natriuretic Peptide Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department.
- Authors: Gaggin HK, Chen-Tournoux AA, Christenson RH, Doros G, Hollander JE, Levy PD, Nagurney JT, Nowak RM, Pang PS, Patel D, Peacock WF, Walters EL, Januzzi JL, ICON-RELOADED Investigators.
- Issue date: 2017 Oct
- Diagnostic and Prognostic Utilities of Insulin-Like Growth Factor Binding Protein-7 in Patients With Dyspnea.
- Authors: Ibrahim NE, Afilalo M, Chen-Tournoux A, Christenson RH, Gaggin HK, Hollander JE, Kastner P, Levy PD, Mang A, Masson S, Nagurney JT, Nowak RM, Pang PS, Peacock WF, Dipl-Stat VR, Walters EL, Januzzi JL Jr
- Issue date: 2020 May
- N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study.
- Authors: Januzzi JL Jr, Chen-Tournoux AA, Christenson RH, Doros G, Hollander JE, Levy PD, Nagurney JT, Nowak RM, Pang PS, Patel D, Peacock WF, Rivers EJ, Walters EL, Gaggin HK, ICON-RELOADED Investigators.
- Issue date: 2018 Mar 20
- Amino-terminal pro-B-type natriuretic peptide testing and prognosis in patients with acute dyspnea, including those with acute heart failure.
- Authors: Baggish AL, van Kimmenade RR, Januzzi JL Jr
- Issue date: 2008 Feb 4
- Biomarkers and diagnostics in heart failure.
- Authors: Gaggin HK, Januzzi JL Jr
- Issue date: 2013 Dec