engleski

Menage a trois - Laboratory markers of myocardial injury, systemic inflammation, and thrombosis in patients with acute heart failure syndromes: insights from the CATSTAT-HF study

Background: Previous studies have shown that several pathophysiological mechanisms including myocardial injury and activation of thrombotic and inflammation pathways might impact on outcomes among patients with acute heart failure (AHF) syndromes. Purpose: Primary goal of the study was to determine the prevalence of laboratory marker abnormalities with respect to myocardial injury, systemic inflammation, and thrombosis. Secondly, we aimed to examine the association of these laboratory indices with N- terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) class, left- ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR) and glycated hemoglobin (HbA1c) values. Methods: A total of eighty patients with documented AHF according to ESC 2016 HF criteria were consecutively enrolled in the study during 2018. All patients underwent a physical examination, transthoracic echocardiography and blood withdrawal for laboratory analyses. Laboratory markers of principal interest were high-sensitivity cardiac troponin I (hs-cTnI), C-reactive protein (CRP) and D-dimers. Abnormal cut-offs were set according to assay specifications as follows: hs-cTnI ≥15.6 ng/L for women and ≥34.2 ng/L for men, CRP ≥5.0 mg/L, and D-dimers ≥0.5 mg/L. Finally, NT-proBNP, NYHA class, LVEF, eGFR, and HbA1c values were obtained in all patients. Results: Mean age of the cohort was 69.6±10 years, 47.5% were women and a vast majority (88.3%) were in NYHA III class or higher. Median NT-proBNP value was 3333 pg/mL (IQR 1219, 6990) with mean LVEF of 42%, mean eGFR of 57 mL/min/1.73 m2 , and mean HbA1c of 6.6%. Median values of examined laboratory markers were 20.3 ng/L (IQR 11.1, 36.5), 10.5 mg/L (IQR 5.9, 23.3) and 1.1 mg/L (IQR 0.7, 2.2) for hs- cTnI, CRP and D-dimer, respectively. Abnormalities of these markers were common in the observed cohort with 73.7%, 69.8%, and 47.9% of patients having abnormal CRP, D-dimer and hs-cTnI levels, respectively (Figure 1). One fifth (20.8%) of the cohort did not have an abnormality in any of the aforementioned markers. A total number of laboratory abnormalities positively correlated with NYHA class (r=0.448, p=0.002). hs-cTnI values correlated positively with NYHA class (r=0.374, p=0.021), HbA1c (r=0.312, p=0.014) and negatively with LVEF (r=-0.344, p=0.041). CRP correlated negatively with estimated glomerular filtration rate (r=-0.345, p=0.002) and positively with HbA1c (r=0.316, p=0.010). D-dimer values positively correlated to CRP (r=0.495, p=0.016) and NT-proBNP (r=0.330, p<0.05). Conclusions: Abnormalities of laboratory markers that reflect myocardial injury, systemic inflammation and thrombosis are highly prevalent among patients with AHF syndromes. These markers generally appear to be associated with worse cardiovascular, renal and glycemic parameters.

acute heart failure ; thrombosis ; inflammation ; myocardial injury ; CRP ; D-dimer ; hs-Troponin-I

nije evidentirano