Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Sep 20;3(2):e000485.
doi: 10.1136/openhrt-2016-000485. eCollection 2016.

Combined biomarker testing for the prediction of left ventricular remodelling in ST-elevation myocardial infarction

Sebastian Johannes Reinstadler  1 , Hans-Josef Feistritzer  1 , Martin Reindl  1 , Gert Klug  1 , Agnes Mayr  2 , Johannes Mair  1 , Werner Jaschke  2 , Bernhard Metzler  1
Affiliations

Combined biomarker testing for the prediction of left ventricular remodelling in ST-elevation myocardial infarction

Sebastian Johannes Reinstadler et al. Open Heart. .

Abstract

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.

Keywords: ST-elevation myocardial infarction; biomarker; cardiac magnetic resonance imaging; left ventricular remodeling.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study patients. CMRI, cardiac MRI, LVR, left ventricular remodelling.
Figure 2
Figure 2
ROC curve analysis for the prediction of LVR by investigated routine biomarkers and their combination. NT-proBNP, N-terminal pro B-type natriuretic peptide, hs-cTnT, high-sensitivity cardiac troponin T, AST, aspartate aminotransferase, ALT, alanine transaminase, hs-CRP, high-sensitivity C reactive protein, LDH, lactate dehydrogenase, LVR, left ventricular remodelling; ROC, receiver operating characteristic.
See this image and copyright information in PMC

References

    1. McManus DD, Gore J, Yarzebski J et al. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011;124:40–7. 10.1016/j.amjmed.2010.07.023 - DOI - PMC - PubMed
    1. Jernberg T, Johanson P, Held C et al. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011;305:1677–84. 10.1001/jama.2011.522 - DOI - PubMed
    1. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol 2000;35:569–82. - PubMed
    1. Altara R, Manca M, Sabra R et al. Temporal cardiac remodeling post-myocardial infarction: dynamics and prognostic implications in personalized medicine. Heart Fail Rev 2015:21;25–47. 10.1007/s10741-015-9513-8 - DOI - PubMed
    1. Kramer DG, Trikalinos TA, Kent DM et al. Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach. J Am Coll Cardiol 2010;56:392–406. 10.1016/j.jacc.2010.05.011 - DOI - PMC - PubMed

Publication types

LinkOut - more resources