Multimarker strategy for heart failure prognostication. Value of neurohormonal biomarkers: neprilysin vs NT-proBNP.

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  • dc.contributor.author Bayes-Genis, Antonica
  • dc.contributor.author Barallat, Jaumeca
  • dc.contributor.author Galán, Amparoca
  • dc.contributor.author Antonio, Marta deca
  • dc.contributor.author Domingo, Marca
  • dc.contributor.author Zamora, Elisabetca
  • dc.contributor.author Gastelurrutia, Palomaca
  • dc.contributor.author Vila, Joanca
  • dc.contributor.author Peñafiel Muñoz, Judithca
  • dc.contributor.author Galvez-Monton, Carolinaca
  • dc.contributor.author Lupón, Josepca
  • dc.date.accessioned 2016-02-29T09:32:06Z
  • dc.date.available 2016-12-31T03:00:03Z
  • dc.date.issued 2015
  • dc.description.abstract INTRODUCTION AND OBJECTIVES: Neprilysin breaks down numerous vasoactive peptides. The soluble form of neprilysin, which was recently identified in heart failure, is associated with cardiovascular outcomes. Within a multibiomarker strategy, we directly compared soluble neprilysin and N-terminal pro-B-type natriuretic peptide as risk stratifiers in a real-life cohort of heart failure patients. METHODS: Soluble neprilysin, N-terminal pro-B-type natriuretic peptide, ST2, and high-sensitivity troponin T levels were measured in 797 consecutive ambulatory heart failure patients followed up for 4.7 years. Comprehensive multivariable analyses and soluble neprilysin vs N-terminal pro-B-type natriuretic peptide head-to-head assessments of performance were performed. A primary composite endpoint included cardiovascular death or heart failure hospitalization. A secondary endpoint explored cardiovascular death alone. RESULTS: Median soluble neprilysin and N-terminal pro-B-type natriuretic peptide concentrations were 0.64ng/mL and 1187 ng/L, respectively. Both biomarkers significantly correlated with age (P<.001) and ST2 (P<.001), but only N-terminal pro-B-type natriuretic peptide significantly correlated with estimated glomerular filtration rate (P<.001), body mass index (P<.001), left ventricular ejection fraction (P=.02) and high-sensitivity troponin T (P<.001). In multivariable Cox regression analyses, soluble neprilysin remained independently associated with the composite endpoint (hazard ratio=1.14; 95% confidence interval, 1.02-1.27; P=.03) and cardiovascular death (hazard ratio=1.15; 95% confidence interval, 1.01-1.31; P=.04), but N-terminal pro-B-type natriuretic peptide did not. The head-to-head soluble neprilysin vs N-terminal pro-B-type natriuretic peptide comparison showed good calibration and similar discrimination and reclassification for both neurohormonal biomarkers, but only soluble neprilysin improved overall goodness-of-fit. CONCLUSIONS: When added to a multimarker strategy, soluble neprilysin remained an independent prognosticator, while N-terminal pro-B-type natriuretic peptide lost significance as a risk stratifier in ambulatory patients with heart failure. Both biomarkers performed similarly in head-to-head analyses.ca
  • dc.description.sponsorship We acknowledge Redes Temáticas de Investigación Cooperativa en Salud (RETICS), Red Cardiovascular (RD12/0042/0047; Postdoctoral RIC fellowship), Red de Terapia Celular–TerCel [RD12/0019/0029], and Ministerio de Economía y Competitividad (Juan de la Cierva, JCI-2012-14025)
  • dc.format.mimetype application/pdfca
  • dc.identifier.citation Bayes-Genis A, Barallat J, Galán A, Antonio M de, Domingo M, Zamora E. et al. Multimarker strategy for heart failure prognostication. Value of neurohormonal biomarkers: neprilysin vs NT-proBNP. Rev Esp Cardiol (Engl Ed). 2015 Dec;68(12):1075-84. doi: 10.1016/j.rec.2015.07.001.ca
  • dc.identifier.doi http://dx.doi.org/10.1016/j.rec.2015.07.001
  • dc.identifier.issn 1885-5857
  • dc.identifier.uri http://hdl.handle.net/10230/25955
  • dc.language.iso eng
  • dc.publisher Elsevierca
  • dc.relation.ispartof Revista Española de Cardiología. 2015 Dec;68(12):1075-84
  • dc.rights © 2015 Elsevier, Bayes-Genis A, Barallat J, Galán A, Antonio M de, Domingo M, Zamora E. et al. Multimarker strategy for heart failure prognostication. Value of neurohormonal biomarkers: neprilysin vs NT-proBNP. Rev Esp Cardiol (Engl Ed). 2015 Dec;68(12):1075-84. doi: 10.1016/j.rec.2015.07.001.ca
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.subject.other Infart de miocardica
  • dc.subject.other Insuficiència cardíacaca
  • dc.subject.other Marcadors bioquímicsca
  • dc.title Multimarker strategy for heart failure prognostication. Value of neurohormonal biomarkers: neprilysin vs NT-proBNP.ca
  • dc.type info:eu-repo/semantics/articleca
  • dc.type.version info:eu-repo/semantics/acceptedVersionca

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