Clinical Investigation
Cardiotrophin-1 Predicts Death or Heart Failure Following Acute Myocardial Infarction

https://doi.org/10.1016/j.cardfail.2006.06.470Get rights and content

Abstract

Background

Cardiotrophin-1 (CT-1) is an important inflammatory cytokine; its presence has been documented in patients after acute myocardial infarction (AMI). However, its role as a predictor of death or heart failure is unclear. We sought to investigate this and compared it with N terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of death or heart failure.

Methods and Results

We studied 291 post-AMI patients. The plasma concentration of CT-1 and NT-proBNP was determined using in-house noncompetitive immunoassays and patients followed for death or heart failure. There were 27 deaths and 19 readmissions with heart failure. CT-1 was raised in patients with death or heart failure compared with survivors (median [range] fmol/mL, 0.9 [0.1–392.2] vs. 0.67 [0–453.3], P = .019). Using a multivariate binary logistic model CT-1 (OR 1.8, 95% CI: 1.1–3.2, P = .031) and NT-proBNP (OR 2.4, 95% CI: 1.1–5.2, P = .026) predicted death or heart failure independently of age, sex, previous AMI, serum creatinine, and Killip class. The receiver-operating curve for CT-1 yielded an area under the curve (AUC) of 0.62 (95% CI: 0.53–0.70, P = .017); for NT-proBNP the AUC was 0.77 (95% CI: 0.69–0.86, P < .001); the logistic model combining the 2 markers yielded an AUC of 0.84 (95% CI: 0.78–0.91, P < .001).

Conclusion

After an AMI, combined levels of CT-1 and NT-proBNP are more informative at predicting death or heart failure than either marker alone.

Section snippets

Study Population

We studied 291 consecutive AMI patients admitted to the Coronary Care Unit of Leicester Royal Infirmary. The study complied with the Declaration of Helsinki and was approved by the local ethics committee; written informed consent was obtained from patients. AMI was defined at presentation with at least 2 of 3 standard criteria: appropriate symptoms, acute electrocardiograph changes of infarction (ST elevation or depression, new left bundle branch block), and a rise in troponin T above the 99th

Patient Characteristics

The demographic features of the patient population are shown in Table 1. Median length of follow-up was 336 days with a range of 0 to 645 days. Of the patients enrolled, 153 (52.6 %) received thrombolysis during the index admission. No patient was lost to follow-up. During follow-up, 27 (9.3%) patients died and 19 (6.5%) were readmitted with heart failure. Echocardiographic data were available for 252 (86.6%) of the 291 patients and done at median of 3.5 days (range 2–5) after presentation with

Discussion

Reperfusion therapy has improved mortality after MI; however the outcome of patients despite this is still poor18; for this reason, risk stratification remains important and may be useful in helping to select treatment regimes in the future. A multimarker strategy has benefits in that it uses the different pathways that are involved in the development and outcome of an AMI in the hope that complementary information can be gained.19 The aim of this study was to assess the utility of CT-1 and

Acknowledgment

The authors thank Sonja Jennings for expert technical assistance.

References (20)

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    Therefore, CT-1 may represent a diagnostic and prognostic biomarker of cardiovascular diseases (Calabro et al., 2009). CT-1 predicts death or HF following acute MI, and combined levels of CT-1 and N-terminal pro B-type natriuretic peptide (NT-proBNP) are more informative in predicting death or HF than either marker alone (Khan et al., 2006). In essential hypertension, an association between left ventricular hypertrophy and plasma concentrations of CT-1 was found.

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    Khan et al. studied 291 patients with acute myocardial infarction, and found that plasma concentration of CT-1 at 25–48 h after the onset of chest pain was raised in patients with death or heart failure as compared with survivors. Combination of CT-1 and N-terminal BNP in a multimarker risk stratification approach is more informative at predicting death or heart failure than either marker alone [103]. Role of CT-1 in the experimental models of myocardial infarction was studied by several investigators.

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Dr. Sohail Q. Khan is supported by a British Heart Foundation Junior Research Fellowship (FS/03/028/15486).

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