Susanne Bauer, Susanne Bauer, Christina Strack, Ute Hubauer, Ekrem Ücer, Stefan Wallner, Andreas Luchner, Lars Maier, Carsten Jungbauer and Andreas Luchner
Background: Chronic heart failure is a complex disease associated with various pathophysiological and biochemical disorders. We assessed the 10 years prognostic role of a multimarker panel of markers for myocyte stress (GDF-15), extra-cellular matrix remodelling (Galectin-3, mimecan, TIMP-1), inflammation (Galectin-3), myocyte injury (hs-TnT) and angiogenesis (endostatin, IBP-4, IGF-BP-7, sFlt-1 and PLGF) head-to-head with the biochemical gold-standard NT-proBNP. Methods: Blood samples from 149 patients with heart failure were analysed. After 10 years of follow-up (median follow-up 104 months, IQR 43-117), data regarding rehospitalisation for chronic heart failure and all-cause-mortality were acquired. Results: Regarding Kaplan Meier analysis, all markers, dichotomized according to youden index, were significant predictors for all-cause-mortality (each p <0,05) and for the combined endpoint of all-cause-mortality and rehospitalisation (each p <0,05). Including all markers in Cox Regression analysis, NT-pro-BNP, hs-TnT and IGF-BP7 were independent predictors for both endpoints (each p<0,05). Patients in whom all three markers were elevated had a significant worse long-time-prognosis than patients without elevated markers (risk of all-cause-mortality 90,5% versus 25%, risk of all-cause-mortality or rehospitalisation 97,6% versus 43,7%). In a Cox regression model with clinical relevant parameters (ejection fraction <30%, age, serum creatinine, gender) and the multimarker panel (hs-TnT, NT-pro-BNP, IGF-BP7), all biomarkers remained independent significant predictors for both endpoints beside ejection fraction <30% and male gender (each p<0.05). Conclusion: In a 10-years-follow-up, a combination of three biomarkers with different pathophysiological background (NT-pro-BNP, hs-TnT and IGF-BP7) increased the prognostic value and identified patients with a high risk of mortality and rehospitalisation. Especially IGF-BP7 seems to play an important role regarding prognostication in heart failure.