Immune protein level, combined with BNP, may improve prognostic value of HF risk models
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Addition of soluble urokinase-type plasminogen activator receptor levels to models including B-type natriuretic peptide may improve their prognostic value for patients with HF, researchers reported.
“Several markers have been examined for heart failure and its adverse outcomes, but few have ever shown to be additive to BNP, or sometimes better than BNP, which is what we find here,” Salim S. Hayek, MD, assistant professor of internal medicine and medical director of the University of Michigan Health Frankel Cardiovascular Center, said in a press release. “BNP is [a] marker that varies dramatically depending on the patient’s fluid status. A more stable marker, such as [soluble urokinase-type plasminogen activator receptor], that is linked to the pathophysiology of heart failure, could be more useful in identifying patients at higher, long-term risk of disease progression or death.”
Hayek and colleagues hypothesized that, as a marker of immune activation and pathogenic factor for kidney disease, soluble urokinase-type plasminogen activator receptor (suPAR) plus BNP may provide better prognostic value in patients with HF and compared with BNP alone.
For the study, researchers measured plasma suPAR and BNP levels in 3,437 adult participants undergoing cardiac catheterization for suspected or confirmed CAD enrolled in the Emory Cardiovascular Biobank, of whom 32.5% also had HF. Of those with HF, the mean age was 65 years, 67% were men, 20% were Black and 67% had reduced ejection fraction.
To assess measured plasma suPAR and BNP levels, fasting arterial blood samples were collected at the time of catheterization. Participants were followed up via phone, electronic medical record, Social Security death index and state records (median follow-up, 6.2 years).
The primary outcome was a composite of incident adverse CV events, including all-cause death, CV death and new diagnosis or HF hospitalization.
Researchers observed median 17% higher levels of suPAR in patients with HF compared with patients without (3,370 pg/mL vs. 2,880 pg/mL; P < .001).
In patients with HF, every 100% increase in suPAR level was independently associated with increased risk for all-cause death (adjusted HR = 2.3; 95% CI, 1.9-2.77), CV death (aHR = 2.33; 95% CI, 1.81-2.99) and HF hospitalization (aHR = 1.96; 95% CI, 1.06-1.25), even after adjustment for BNP, and persisted across subgroups regardless of ejection fraction or presence of ischemic or nonischemic cardiomyopathy.
Moreover, the addition of suPAR to a model including BNP levels improved its prognostic value for death (improvement in C statistic = 0.027), CV death (improvement in C statistic = 0.017) and HF hospitalization (improvement in C statistic = 0.017) in the setting of HF, according to the researchers.
“There is a potential for suPAR to be among the biomarkers that we measure to create a strategy for personalizing care for individual patients,” Arshed Ali Quyyumi, MD, FACC, director of the Emory Clinical Cardiovascular Institute and professor of medicine in the division of cardiology at Emory University School of Medicine, said in the press release. “For example, we could use it to differentiate between admitted patients who are at low and high risk of worsening heart failure. Then we could better allocate postdischarge resources to those at higher risk, which would lessen the cost burden of managing disease. There are many potential opportunities to use suPAR to improve care.”
Reference:
- Immune marker suPAR high in patients with heart failure, predicts risk and death. labblog.uofmhealth.org/lab-report/immune-marker-supar-high-patients-heart-failure-predicts-risk-and-death. Published Oct. 14, 2022. Accessed Oct. 18, 2022.
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