Impact of diabetes on the predictive value of heart failure biomarkersReport as inadecuate

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Cardiovascular Diabetology

, 15:151

First Online: 03 November 2016Received: 17 July 2016Accepted: 26 October 2016


BackgroundPatients with diabetes mellitus DM have an increased risk of developing heart failure HF. Further, DM is associated with poor prognosis in patients with HF. Our aim was to determine whether DM has any impact on the predictive value of a multi-biomarker panel in patients with HF.

MethodsWe included 1069 consecutive ambulatory HF patients in the study: age 66.2 ± 12.8 years, 33.5 ± 13.3 left ventricular ejection fraction, 36% diabetic patients. We measured serum concentrations of N-terminal pro-brain natriuretic peptide NT-proBNP, high-sensitivity troponin T hs-TnT, ST2, galectin-3, high-sensitivity C reactive protein hs-CRP, cystatin-C, soluble transferrin receptor sTfR, and neprilysin and followed patients for 4.9 ± 2.8 years. Primary endpoints were all-cause and cardiovascular death.

ResultsDuring follow-up, 534 patients died; 283 died of cardiovascular causes. Diabetic subjects had higher mortality 57.7 vs. 45.6%, p < 0.001. NTproBNP p = 0.07, hs-TnT p < 0.001, galectin-3 p < 0.001, and cystatin-C p = 0.001 concentrations were higher in diabetic patients, whereas sTfR levels were lower p = 0.005. There were no interactions between DM and NTproBNP, hs-TnT, galectin-3, hs-CRP, cystatin-C, sTfR, and neprilysin relative to risk prediction for all-cause or cardiovascular death. By contrast, ST2 significantly interacted with DM for all-cause p = 0.02 and cardiovascular p = 0.03 death. In diabetic patients, HRs for ST2 were 1.27 95% CI 1.16–1.40, p < 0.001 and 1.23 95% CI 1.09–1.39, p = 0.001 for all-cause and cardiovascular death, respectively. In nondiabetic patients, HRs for ST2 were 1.53 95% CI 1.35–1.73, p < 0.001 and 1.64 95% CI 1.31–2.05, p < 0.001 for all-cause and cardiovascular death, respectively. The multivariable Cox regression analysis showed that hs-TnT and ST2 were the only markers that were independently associated with both all-cause and cardiovascular mortality in patients with HF and diabetes. Moreover, in these patients, the combination of these two markers significantly increased discrimination as assessed by the area under the curve.

ConclusionsBiomarkers used in the general population to predict the clinical course of heart failure are also useful in patients with diabetes. In these patients, among all the biomarkers analysed only hs-TnT and ST2 were independently associated with both all-cause and cardiovascular mortality.

KeywordsDiabetes mellitus Heart failure Biomarkers ST2 Prognostic AbbreviationsDMdiabetes mellitus

HFheart failure

hs-TnThigh-sensitivity troponin T

hs-CRPhigh-sensitivity C reactive protein

sTfRsoluble transferrin receptor

LVEFleft ventricular ejection fraction

NYHANew York Heart Association

NT-proBNPN-terminal pro-brain natriuretic peptide

Nuria Alonso, Josep Lupón, Dídac Mauricio and Antoni Bayes-Genis contributed equally to this work

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Author: Nuria Alonso - Josep Lupón - Jaume Barallat - Marta de Antonio - Mar Domingo - Elisabet Zamora - Pedro Moliner - Amparo G



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