Biomarkers in outpatient heart failure management; Are they correlated to and do they influence clinical judgment?

AIMS: Heart failure (HF) management is complicated by difficulties in clinical assessment. Biomarkers may help guide HF management, but the correspondence between clinical evaluation and biomarker serum levels has hardly been studied. We investigated the correlation between biomarkers and clinical signs and symptoms, the influence of patient characteristics and comorbidities on New York Heart Association (NYHA) classification and the effect of using biomarkers on clinical evaluation. METHODS AND RESULTS: This post-hoc analysis comprised 622 patients (77 ± 8 years, 76 % NYHA class ≥3, 80 % LVEF ≤45 %) participating in TIME-CHF, randomising patients to either NT-proBNP-guided or symptom-guided therapy. Biomarker measurements and clinical evaluation were performed at baseline and after 1, 3, 6, 12 and 18 months. NT-proBNP, GDF-15, hs-TnT and to a lesser extent hs-CRP and cystatin-C were weakly correlated to NYHA, oedema, jugular vein distension and orthopnoea (ρ-range: 0.12-0.33; p < 0.01). NT-proBNP correlated more strongly to NYHA class in the NT-proBNP-guided group compared with the symptom-guided group. NYHA class was significantly influenced by age, body mass index, anaemia, and the presence of two or more comorbidities. CONCLUSION: In HF, biomarkers correlate only weakly with clinical signs and symptoms. NYHA classification is influenced by several comorbidities and patient characteristics. Clinical judgement seems to be influenced by a clinician's awareness of NT-proBNP concentrations.

Prognostic impact of systemic inflammatory diseases in elderly patients with congestive heart failure.

BACKGROUND AND AIMS: Inflammation is part of the pathophysiology of congestive heart failure (CHF). However, little is known about the impact of the presence of systemic inflammatory disease (SID), defined as inflammatory syndrome with constitutional symptoms and involvement of at least two organs as co-morbidity on the clinical course and prognosis of patients with CHF. METHODS AND RESULTS: This is an analysis of all 622 patients included in TIME-CHF. After an 18 months follow-up, outcomes of patients with and without SID were compared. Primary endpoint was all-cause hospitalization free survival. Secondary endpoints were overall survival and CHF hospitalization free survival. At baseline, 38 patients had history of SID (6.1%). These patients had higher N-terminal pro brain natriuretic peptide and worse renal function than patients without SID. SID was a risk factor for adverse outcome [primary endpoint: hazard ratio (HR) = 1.73 (95% confidence interval: 1.18-2.55, P = 0.005); survival: HR = 2.60 (1.49-4.55, P = 0.001); CHF hospitalization free survival: HR = 2.3 (1.45-3.65, P < 0.001)]. In multivariate models, SID remained the strongest independent risk factor for survival and CHF hospitalization free survival. CONCLUSION: In elderly patients with CHF, SID is independently accompanied with adverse outcome. Given the increasing prevalence of SID in the elderly population, these findings are clinically important for both risk stratification and patient management.

Crystallographic and chemical analysis of human bone apatite (Crista Iliaca).

Crystallographic (X-ray diffraction) and chemical (X-ray fluorescence and combustion analysis) investigations on bone microsamples (human iliac crest of 111 individuals aged 0-90 years) reveal that certain crystallographic and chemical parameters (lattice parameters, crystallinity, chemical compounds, biomineralic fraction...) are closely related to aging and type of tissue (corticalis and spongiosa). In juvenile bone [0-25y], the biomineralic fraction rises significantly, as does crystallinity and area of apatite (002)-reflection indicating a growth of crystal size. The second main age interval [25-50y] does not display statistically relevant variations with age. The third main age group [50-90y] is characterized by large chemical variations, probably due to overlapping effects of age and declining health.

Crystallographic lattice refinement of human bone.

X-ray diffraction studies on bone microsamples (human iliac crest of 87 individuals aged 0-90 years) reveal that certain crystallographic parameters such as unit cell volume of bone apatite, and half-width of (002)-reflection are well correlated with age and with type of tissue (corticalis and spongiosa). Similar to inorganic apatite, the lattice parameters of bone apatite are intensely affected by ionic substitutions and vary mainly due to exchange of hydroxyl- and carbonate-apatite and, to a minor extent, of fluor- and chlorapatite.