Multimarker approach to risk stratification among patients with advanced chronic heart failure

Background: Cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) each predict adverse cardiac events in chronic heart failure (CHF). However, little is known about the utility of these novel biomarkers of CHF in combination. Hypothesis: We hypothesized that simultaneous assessment of the three biomarkers would enable clinicians to stratify risk more effectively among patients with advanced CHF. Methods: Measurements of the biomarkers were performed on 152 patients with symptomatic advanced CHF. Major adverse cardiac events during a median follow-up period of 186 days were determined. Results: Univariate and multivariate analysis revealed that elevations of each biomarker were significant predictors of clinical outcome independently of clinical variables. When patients were categorized on the basis of the number of elevated biomarkers, patients with one, two and three elevated biomarkers respectively had a 2.7-(p = 0.125), 8.6- (p < 0.0001) and 23.4-(p < 0.0001) fold increase in the risk of adverse events. Conclusions: Simultaneous measurement of cTnI, hs-CRP, and NT-proBNP could provide complementary information and a simple multimarker strategy that categorizes the patients with advanced CHF based on the number of elevated biomarkers, allowing rapid risk stratification in these patients.