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Eggers, K. M., Batra, G., Lindahl, B., Lakic, T., Lindbäck, J., Budaj, A., . . . Wallentin, L. (2024). Temporal biomarker concentration patterns during the early course of acute coronary syndrome. Clinical Chemistry and Laboratory Medicine, 62(6), 1167-1176
Open this publication in new window or tab >>Temporal biomarker concentration patterns during the early course of acute coronary syndrome
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2024 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 62, no 6, p. 1167-1176Article in journal (Refereed) Published
Abstract [en]

Objectives: Biomarker concentrations and their changes during acute coronary syndrome (ACS) provide clinically useful information on pathophysiological processes, e.g. myocardial necrosis, hemodynamic stress and inflammation. However, current evidence on temporal biomarker patterns early during ACS is limited, and studies investigating multiple biomarkers are lacking.

Methods: We measured concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), NT-terminal pro-B-type natriuretic peptide, C-reactive protein, and growth-differentiation factor-15 (GDF-15) in plasma samples obtained at randomization in ACS patients from the PLATelet inhibition and patient Outcomes (PLATO) trial. Linear regressions with interaction analyses were used to investigate the associations of biomarker concentrations with the time from symptom onset and to model temporal biomarker concentration patterns.

Results: The study population consisted of 16,944 patients (median age 62 years; 71.3 % males) with 6,853 (40.3 %) having ST-elevation myocardial infarction (STEMI) and 10,141 (59.7 %) having non-ST-elevation ACS (NSTE-ACS). Concentrations of all biomarkers were associated with time from symptom onset (pinteraction<0.001), apart for GDF-15 (pinteraction=0.092). Concentration increases were more pronounced in STEMI compared to NSTE-ACS. Temporal biomarker patterns for hs-cTnT and hs-cTnI were different depending on sex whereas biomarker patterns for the other biomarkers were similar in cohorts defined by age and sex.

Conclusions: Temporal concentration patterns differ for various biomarkers early during ACS, reflecting the variability in the activation and duration of different pathophysiological processes, and the amount of injured myocardium. Our data emphasize that the time elapsed from symptom onset should be considered for the interpretation of biomarker results in ACS.

Place, publisher, year, edition, pages
Walter de Gruyter, 2024
Keywords
acute coronary syndrome, biomarkers, temporal concentration pattern
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-528143 (URN)10.1515/cclm-2023-1253 (DOI)001159349800001 ()38341860 (PubMedID)
Funder
AstraZenecaSwedish Foundation for Strategic Research, RB13-0197
Available from: 2024-05-23 Created: 2024-05-23 Last updated: 2024-05-23Bibliographically approved
Hjort, M., Eggers, K. M., Ghukasyan Lakic, T., Lindbäck, J., Budaj, A., Cornel, J. H., . . . Lindahl, B. (2023). Biomarker Concentrations and Their Temporal Changes in Patients With Myocardial Infarction and Nonobstructive Compared With Obstructive Coronary Arteries: Results From the PLATO Trial. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 12(1), Article ID e027466.
Open this publication in new window or tab >>Biomarker Concentrations and Their Temporal Changes in Patients With Myocardial Infarction and Nonobstructive Compared With Obstructive Coronary Arteries: Results From the PLATO Trial
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2023 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 12, no 1, article id e027466Article in journal (Refereed) Published
Abstract [en]

Background: The pathobiology of myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is often uncertain. Investigating biomarker concentrations and their changes may offer novel pathophysiological insights.

Methods and Results: In this post hoc study of the PLATO (Platelet Inhibition and Patient Outcomes) trial, concentrations of hs‐cTnT (high‐sensitivity cardiac troponin T), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), hs‐CRP (high‐sensitivity C‐reactive protein), and GDF‐15 (growth differentiation factor 15) were measured in patients with MINOCA at baseline (n=554) and at 1‐month follow‐up (n=107). For comparisons, biomarkers were also measured in patients with MI with obstructive (stenosis ≥50%) coronary artery disease (baseline: n=11 106; follow‐up: n=2755]). Adjusted linear regression models were used to compare concentrations and their short‐ and long‐term changes. The adjusted geometric mean ratios (GMRs) in patients with MINOCA (median age, 61 years; 50.4% women) indicated lower hs‐cTnT (GMR, 0.77 [95% CI, 0.68–0.88]) but higher hs‐CRP (GMR, 1.21 [95% CI, 1.08–1.37]) and GDF‐15 concentrations (GMR, 1.06 [95% CI, 1.02–1.11]) at baseline compared with patients with MI with obstructive coronary artery disease, whereas NT‐proBNP concentrations were similar. Temporal decreases in hs‐cTnT, NT‐proBNP, and hs‐CRP concentrations until 1‐month follow‐up were more pronounced in patients with MINOCA. At follow‐up, patients with MINOCA had lower concentrations of hs‐cTnT (GMR, 0.71 [95% CI, 0.60–0.84]), NT‐proBNP (GMR, 0.45 [95% CI, 0.36–0.56]), and hs‐CRP (GMR, 0.68 [95% CI, 0.53–0.86]). One‐month GDF‐15 concentrations were similar between both groups with MI.

Conclusions: Biomarker concentrations suggest greater initial inflammatory activity, similar degree of myocardial dysfunction, and less pronounced myocardial injury during the acute phase of MINOCA compared with MI with obstructive coronary artery disease but also faster myocardial recovery.

CLINICAL TRAIL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

Place, publisher, year, edition, pages
American heart association, 2023
Keywords
myocardial infarction; MINOCA; biomarkers; pathophysiology, hjärtinfarkt, MINOCA, biomarkörer, patofysiologi
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-470388 (URN)10.1161/JAHA.122.027466 (DOI)000906944100034 ()36565198 (PubMedID)
Funder
Swedish Foundation for Strategic Research, RB13-0197Swedish Association of Local Authorities and RegionsAstraZeneca
Note

Title in dissertation list of papers: Biomarker concentrations and their temporal changes in myocardial infarction patients with non-obstructive compared to obstructive coronary arteries: results from the PLATelet inhibition and patient Outcomes (PLATO) trial

Available from: 2022-04-05 Created: 2022-04-05 Last updated: 2024-07-04Bibliographically approved
Eggers, K. M., Hammarsten, O. & Lindahl, B. (2023). Differences between high-sensitivity cardiac troponin T and I in stable populations: underlying causes and clinical implications. Clinical Chemistry and Laboratory Medicine, 61(3), 380-387
Open this publication in new window or tab >>Differences between high-sensitivity cardiac troponin T and I in stable populations: underlying causes and clinical implications
2023 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 61, no 3, p. 380-387Article in journal (Refereed) Published
Abstract [en]

 Objectives

Measurement of high-sensitivity (hs) cardiac troponin (cTn) T and I is widely studied for cardiac assessment of stable populations. Recent data suggest clinical and prognostic discrepancies between both hs-cTn. We aimed at reviewing published studies with respect to underlying causes and clinical implications.

Content

We summarized current evidence on release and clearance mechanisms of cTnT and I, and on preanalytical and assay-related issues potentially portending to differences in measured concentrations. We also performed a systematic review of outcome studies comparing both hs-cTn in the general population, patients with congestive heart failure, stable coronary artery disease and atrial fibrillation.

Summary and outlook

For the interpretation of concentrations of hs-cTnT, stronger association with renal dysfunction compared to hs-cTnI should be considered. Hs-cTnT also appears to be a stronger indicator of general cardiovascular morbidity and all-cause mortality. Hs-cTnI concentrations tend to be more sensitive to coronary artery disease and ischemic outcomes. These findings apparently reflect variations in the mechanisms of cardiac affections resulting in cTn release. Whether these differences are of clinically relevance remains to be elucidated. However, having the option of choosing between either hs-cTn might represent an option for framing individualized cardiac assessment in the future.

Place, publisher, year, edition, pages
Walter de Gruyter, 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-489748 (URN)10.1515/cclm-2022-0778 (DOI)000890724400001 ()
Available from: 2022-12-04 Created: 2022-12-04 Last updated: 2023-05-16Bibliographically approved
Löfmark, H., Muhrbeck, J., Eggers, K. M., Linder, R., Ljung, L., Martinsson, A., . . . Jernberg, T. (2023). HEART-score can be simplified without loss of discriminatory power in patients with chest pain: Introducing the HET-score. American Journal of Emergency Medicine, 74, 104-111
Open this publication in new window or tab >>HEART-score can be simplified without loss of discriminatory power in patients with chest pain: Introducing the HET-score
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2023 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 74, p. 104-111Article in journal (Refereed) Published
Abstract [en]

Background

The History, Electrocardiogram (ECG), Age, Risk factors and Troponin, (HEART) score is useful for early risk stratification in chest pain patients. The aim was to validate previous findings that a simplified score using history, ECG and troponin (HET-score) has similar ability to stratify risk.

Methods

Patients presenting with chest pain with duration of ≥10 min and an onset of last episode ≤12 h but without ST-segment elevation on ECG at 6 emergency departments were eligible for inclusion. The HEART-score and the simplified HET-score were calculated. The endpoint was a composite of myocardial infarction (MI) as index diagnosis, readmission due to new MI or death within 30 days.

Results

HEART-score identified 32% as low risk (0-2p), 47% as intermediate risk (3-5p), and 20% as high risk (6-10p) patients. The endpoint occurred in 0.5%, 7.3% and 35.7%, respectively. HET-score identified 39%, 42% and 19% as low- (0p), intermediate- (1-2p) and high-risk (3-6p) patients, with the endpoint occurring in 0.6%, 6.2% and 43.2%, respectively.

When all variables included in the HEART-score were included in a multivariable logistic regression analysis, only History (OR, CI [95%]): 2.97(2.16–4.09), ECG (1.61[1.14–2.28]) and troponin level (5.21[3.91–6.95]) were significantly associated with cardiovascular events. When HEART- and HET-score were compared in a ROC-analysis, HET-score had a significantly larger AUC (0.887 vs 0.853, p < 0.001).

Conclusions

Compared with HEART-score, HET-score is simpler and appears to have similar ability to discriminate between chest pain patients with and without cardiovascular event.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Chest pain, Acute coronary syndrome, Score, Diagnosis, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-516342 (URN)10.1016/j.ajem.2023.09.037 (DOI)001092097300001 ()37804822 (PubMedID)
Funder
EU, FP7, Seventh Framework ProgrammeSwedish Heart Lung FoundationRegion Stockholm
Available from: 2023-11-22 Created: 2023-11-22 Last updated: 2023-11-22Bibliographically approved
Eggers, K. M., Baron, T., Chapman, A. R., Gard, A. & Lindahl, B. (2023). Management and outcome trends in type 2 myocardial infarction: an investigation from the SWEDEHEART registry. Scientific Reports, 13(1), Article ID 7194.
Open this publication in new window or tab >>Management and outcome trends in type 2 myocardial infarction: an investigation from the SWEDEHEART registry
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 7194Article in journal (Refereed) Published
Abstract [en]

Despite poor prognosis, patients with type 2 myocardial infarction (MI) tend to be underdiagnosed and undertreated compared to those with type 1 MI. Whether this discrepancy has improved over time is uncertain. We conducted a registry-based cohort study investigating type 2 MI patients managed at Swedish coronary care units (n = 14,833) during 2010–2022. Multivariable-adjusted changes (first three vs last three calendar years of the observation period) were assessed regarding diagnostic examinations (echocardiography, coronary assessment), provision of cardioprotective medications (betablockers, renin–angiotensin–aldosterone-system inhibitors, statins) and 1-year all-cause mortality. Compared to type 1 MI patients (n = 184,329), those with type 2 MI less often had diagnostic examinations and cardioprotective medications. Increases in the use of echocardiography (OR 1.08 [95% confidence interval 1.06–1.09]) and coronary assessment (OR 1.06 [95% confidence interval 1.04–1.08]) were smaller compared to type 1 MI (pinteraction < 0.001). The provision of medications did not increase in type 2 MI. All-cause mortality rate in type 2 MI was 25.4% without temporal change (OR 1.03 [95% confidence interval 0.98–1.07]). Taken together, the provision of medications and all-cause mortality did ot improve in type 2 MI despite modest increases in diagnostic procedures. This emphasizes the need of defining optimal care pathways in these patients.

Place, publisher, year, edition, pages
Springer Nature, 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-504947 (URN)10.1038/s41598-023-34312-7 (DOI)000984935100053 ()37137939 (PubMedID)
Funder
Swedish Foundation for Strategic ResearchUppsala University
Available from: 2023-06-20 Created: 2023-06-20 Last updated: 2023-06-20Bibliographically approved
Odqvist, M., Bandstein, N., Tygesen, H., Eggers, K. M., Andersson, P.-O. & Holzmann, M. J. (2023). Outcomes in patients with chest pain in emergency departments using high-sensitivity versus conventional troponins. Scandinavian Cardiovascular Journal, 57(1), Article ID 2190546.
Open this publication in new window or tab >>Outcomes in patients with chest pain in emergency departments using high-sensitivity versus conventional troponins
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2023 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 57, no 1, article id 2190546Article in journal (Refereed) Published
Abstract [en]

Objectives: There is a paucity of data regarding the association between the use of high-sensitivity troponin (hs-cTn) compared with conventional troponin (cTn) and outcomes in chest pain patients in emergency departments (EDs). This study examined the impact of hs-cTnT on prognosis in chest pain patients in EDs.

Design: In an observational cohort study, we included chest pain patients visiting the EDs of 14 hospitals in Sweden from 2011 to 2016. The study population was retrieved from each hospital, and information on characteristics and outcomes was collected from nationwide registries. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals (HR, 95% CI) for (1) 1-year all-cause mortality, (2) missed acute coronary syndromes (ACSs), (3) use of coronary angiography, and (4) revascularizations within 30 days.

Results: We included 170461 patients with chest pain where 62669 patients were tested with cTn while 107792 patients were tested with hs-cTnT. We found 4149 (4.6%) deaths in the cTn group and 6087 (3.7%) deaths in the hs-cTnT group. Patients in the hs-cTnT group had 9% lower mortality (0.91, 0.87-0.94), and were 14% more likely to undergo coronary angiography (1.14, 1.10-1.17), and 12% more likely to be revascularized (1.12, 1.08-1.17) than patients in the cTn group.

Conclusions: Patients with chest pain visiting EDs using hs-cTnT had lower mortality and a higher likelihood of undergoing coronary angiographies and revascularizations than those using cTn. There may be a survival benefit of being tested with hs-cTnT compared with cTn in patients seeking medical attention for chest pain.

Place, publisher, year, edition, pages
Taylor & FrancisTAYLOR & FRANCIS LTD, 2023
Keywords
High-sensitivity cardiac troponin, chest pain, emergency department, outcomes, cardic troponin
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-502646 (URN)10.1080/14017431.2023.2190546 (DOI)000985002600001 ()37160719 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20170804Stockholm County Council, 20170686
Available from: 2023-05-31 Created: 2023-05-31 Last updated: 2024-01-15Bibliographically approved
Mörtberg, J., Salzinger, B., Lundwall, K., Edfors, R., Jacobson, S. H., Wallén, H. N., . . . Spaak, J. (2023). Prognostic importance of biomarkers associated with haemostatic, vascular and endothelial disturbances in acute coronary syndrome patients in relation to kidney function.. International Journal of Cardiology, 373, 64-71
Open this publication in new window or tab >>Prognostic importance of biomarkers associated with haemostatic, vascular and endothelial disturbances in acute coronary syndrome patients in relation to kidney function.
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2023 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 373, p. 64-71Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with kidney failure have a high risk for cardiovascular events. We aimed to evaluate the prognostic importance of selected biomarkers related to haemostasis, endothelial function, and vascular regulation in patients with acute coronary syndrome (ACS), and to study whether this association differed in patients with renal dysfunction.

METHODS: Plasma was collected in 1370 ACS patients included between 2008 and 2015. Biomarkers were analysed using a Proximity Extension Assay and a Multiple Reaction Monitoring mass spectrometry assay. To reduce multiplicity, biomarkers correlating with eGFR were selected a priori among 36 plasma biomarkers reflecting endothelial and vascular function, and haemostasis. Adjusted Cox regression were used to study their association with the composite outcome of myocardial infarction, ischemic stroke, heart failure or death. Interaction with eGFR strata above or below 60 ml/min/1.73 m2 was tested.

RESULTS: Tissue factor, proteinase-activated receptor, soluble urokinase plasminogen activator surface receptor (suPAR), thrombomodulin, adrenomedullin, renin, and angiotensinogen correlated inversely with eGFR and were selected for the Cox regression. Mean follow-up was 5.2 years during which 428 events occurred. Adrenomedullin, suPAR, and renin were independently associated with the composite outcome. Adrenomedullin showed interaction with eGFR strata (p = 0.010) and was associated with increased risk (HR 1.88; CI 1.44-2.45) only in patients with eGFR ≥60 ml/min/ 1.73 m2.

CONCLUSIONS: Adrenomedullin, suPAR, and renin were associated with the composite outcome in all. Adrenomedullin, involved in endothelial protection, showed a significant interaction with renal function and outcome, and was associated with the composite outcome only in patients with preserved kidney function.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Proteomics, chronic renal insufficiency, endothelium, haemostasis, myocardial infarction, vascular
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-491556 (URN)10.1016/j.ijcard.2022.12.005 (DOI)000979492400001 ()36476672 (PubMedID)
Funder
Swedish Foundation for Strategic Research, KF10-0024
Available from: 2022-12-21 Created: 2022-12-21 Last updated: 2023-06-19Bibliographically approved
Gedeborg, R., Holm, L., Feltelius, N., Sundström, A., Eggers, K. M., Nurminen, M.-L., . . . Ljung, R. (2023). Validation of myocarditis diagnoses in the Swedish patient register for analyses of potential adverse reactions to COVID-19 vaccines. Upsala Journal of Medical Sciences, 128(1), Article ID e9290.
Open this publication in new window or tab >>Validation of myocarditis diagnoses in the Swedish patient register for analyses of potential adverse reactions to COVID-19 vaccines
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2023 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 128, no 1, article id e9290Article in journal (Refereed) Published
Abstract [en]

Background: Coronavirus disease 2019 (COVID-19) mRNA vaccines are associated with an increased risk of myocarditis using hospital discharge diagnoses as an outcome. The validity of these register-based diagnoses is uncertain.

Methods: Patient records for subjects < 40 years of age and a diagnosis of myocarditis in the Swedish National Patient Register were manually reviewed. Brighton Collaboration diagnosis criteria for myocarditis were applied based on patient history, clinical examination, laboratory data, electrocardiograms, echocardiography, magnetic resonance imaging and myocardial biopsy. Poisson regression was used to estimate incidence rate ratios, comparing the register-based outcome variable to validated outcomes. Interrater reliability was assessed by a blinded re-evaluation.

Results: Overall, 95.6% (327/342) of cases registered as myocarditis were confirmed (definite, probable or possible myocarditis according to Brighton Collaboration diagnosis criteria, positive predictive value 0.96 [95% CI 0.93–0.98]). Of the 4.4% (15/342) cases reclassified as no myocarditis or as insufficient information, two cases had been exposed to the COVID-19 vaccine no more than 28 days before the myocarditis diagnosis, two cases were exposed >28 days before admission and 11 cases were unexposed to the vaccine. The reclassification had only minor impact on incidence rate ratios for myocarditis following COVID-19 vaccination. In total, 51 cases were sampled for a blinded re-evaluation. Of the 30 randomly sampled cases initially classified as either definite or probably myocarditis, none were re-classified after re-evaluation. Of the in all 15 cases initially classified as no myocarditis or insufficient information, 7 were after re-evaluation re-classified as probable or possible myocarditis. This re-classification was mostly due to substantial variability in electrocardiogram interpretation.

Conclusion: This validation of register-based diagnoses of myocarditis by manual patient record review confirmed the register diagnosis in 96% of cases and had high interrater reliability. Reclassification had only a minor impact on the incidence rate ratios for myocarditis following COVID-19 vaccination.

Place, publisher, year, edition, pages
Upsala Medical Society, 2023
Keywords
COVID-19 vaccines, myocarditis, diagnosis, validation study
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-504966 (URN)10.48101/ujms.v128.9290 (DOI)000990716300001 ()37223633 (PubMedID)
Funder
Swedish Medical Products Agency
Available from: 2023-06-16 Created: 2023-06-16 Last updated: 2023-06-16Bibliographically approved
Lind, L., Loader, J., Lindahl, B., Eggers, K. M. & Sundström, J. (2022). A comparison of echocardiographic and circulating cardiac biomarkers for predicting incident cardiovascular disease. PLOS ONE, 17(7), Article ID e0271835.
Open this publication in new window or tab >>A comparison of echocardiographic and circulating cardiac biomarkers for predicting incident cardiovascular disease
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 7, article id e0271835Article in journal (Refereed) Published
Abstract [en]

Background: Echocardiographic measures are known predictors of cardiovascular disease (CVD) in the general population. This study compared the predictive value of such measures to that of circulating cardiac biomarkers for a composite cardiovascular disease outcome in an aging population.

Methods: In this prospective population-based cohort study, echocardiography was performed at baseline together with assessments of traditional CVD risk factors and circulating cardiac biomarkers, NT-proBNP and troponin I, in 1016 individuals all aged 70 years. Assessments were repeated at ages 75 and 80. A composite CVD outcome (myocardial infarction, heart failure or ischemic stroke) was charted over 15 years. All echocardiography variables, except for the E/A ratio, were analyzed on a continuous scale.

Results: Over 10 years, left atrial (LA) diameter, left ventricular mass index (LVMI) and high E/A ratio (>1.5) increased, while left ventricular ejection fraction (LVEF) remained unchanged. Using Cox proportional hazard analyses with time-updated variables for echocardiographic measures and traditional risk factors, an enlarged LA diameter and a low LVEF were independently related to incident CVD in 222 participants. The addition of LA diameter and LVEF to traditional risk factors increased the C-statistic by 1.5% (p = 0.008). However, the addition of troponin I and NT-proBNP to traditional risk factors increased the C-statistic by 3.0% (p<0.001).

Conclusion: An enlarged LA diameter and a low LVEF improved the prediction of incident CVD compared to traditional risk factors. However, given that troponin I and NT-proBNP improved prediction to a similar extent, the use of simple blood tests to improve clinical cardiovascular disease risk prediction is only further supported by this study.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2022
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-489750 (URN)10.1371/journal.pone.0271835 (DOI)000892932200046 ()35877671 (PubMedID)
Funder
EU, Horizon 2020, 898829
Available from: 2022-12-04 Created: 2022-12-04 Last updated: 2023-03-23Bibliographically approved
Vergaro, G., Gentile, F., Aimo, A., Januzzi, J. L., Richards, A. M., Lam, C. S. P., . . . Emdin, M. (2022). Circulating levels and prognostic cut-offs of sST2, hs-cTnT, and NT-proBNP in women vs. men with chronic heart failure. ESC Heart Failure, 9(4), 2084-2095
Open this publication in new window or tab >>Circulating levels and prognostic cut-offs of sST2, hs-cTnT, and NT-proBNP in women vs. men with chronic heart failure
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2022 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 9, no 4, p. 2084-2095Article in journal (Refereed) Published
Abstract [en]

Aims To define plasma concentrations, determinants, and optimal prognostic cut-offs of soluble suppression of tumorigenesis-2 (sST2), high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in women and men with chronic heart failure (HF). Methods and results Individual data of patients from the Biomarkers In Heart Failure Outpatient Study (BIOS) Consortium with sST2, hs-cTnT, and NT-proBNP measured were analysed. The primary endpoint was a composite of 1 year cardiovascular death and HF hospitalization. The secondary endpoints were 5 year cardiovascular and all-cause death. The cohort included 4540 patients (age 67 +/- 12 years, left ventricular ejection fraction 33 +/- 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/mL, P < 0.001) and hs-cTnT level (15 vs. 20 ng/L, P < 0.001), and similar concentrations of NT-proBNP (1540 vs. 1505 ng/L, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut-off was lower in women for sST2 (28 vs. 31 ng/mL) and hs-cTnT (22 vs. 25 ng/L), while NT-proBNP cut-off was higher in women (2339 ng/L vs. 2145 ng/L). The use of sex-specific cut-offs improved risk prediction compared with the use of previously standardized prognostic cut-offs and allowed to reclassify the risk of many patients, to a greater extent in women than men, and for hs-cTnT than sST2 or NT-proBNP. Specifically, up to 18% men and up to 57% women were reclassified, by using the sex-specific cut-off of hs-cTnT for the endpoint of 5 year cardiovascular death. Conclusions In patients with chronic HF, concentrations of sST2 and hs-cTnT, but not of NT-proBNP, are lower in women. Lower sST2 and hs-cTnT and higher NT-proBNP cut-offs for risk stratification could be used in women.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
Chronic heart failure, Sex, Women, Prognosis, sST2, High-sensitivity troponin T, NT-proBNP
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-485911 (URN)10.1002/ehf2.13883 (DOI)000790676800001 ()35510529 (PubMedID)
Available from: 2022-10-17 Created: 2022-10-17 Last updated: 2022-10-17Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-8806-5778

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