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European Journal of Heart Failure Advance Access originally published online on February 19, 2009
European Journal of Heart Failure 2009 11(4):354-360; doi:10.1093/eurjhf/hfp024
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Cystatin C and NT-proBNP, a powerful combination of biomarkers for predicting cardiovascular mortality in elderly patients with heart failure: results from a 10-year study in primary care

Urban Alehagen1,*, Ulf Dahlström1 and Tomas L. Lindahl2

1 Department of Cardiology, Heart Center, Linköping University Hospital SE-581 85 Linkoping, Sweden
2 Department of Clinical Chemistry, Laboratory Medicine Östergötland and Institute of Biomedicine and Surgery, Linköping University Hospital SE-581 85, Sweden

* Corresponding author. Tel: +46 132 22000, Fax: +46 132 22324, Email: urban.alehagen{at}ihs.liu.se


  Abstract

Aims: Heart failure (HF) is common among the elderly patients. It is essential to identify those at high risk in order to optimize the use of resources. We aimed to evaluate whether a combination of two biomarkers might give better prognostic information about the risk of cardiovascular (CV) mortality in patients with symptoms associated with HF, compared with only one biomarker.

Methods and results: Four hundred and sixty-four primary health-care patients (mean age 73 years, range 65–87) with symptoms of HF were examined. All patients were evaluated using Doppler echocardiography and blood samples, including measurement of cystatin C and NT-proBNP. The patients were followed over a 10-year period. Patients with serum cystatin C levels within the highest quartile had almost three times the risk (HR: 2.92; 95% CI: 1.23–4.90) of CV mortality compared with those patients who had levels within the first, second, or third quartiles. If, at the same time, the patient had a plasma concentration of NT-proBNP within the highest quartile, the risk increased to >13 times (HR: 13.61; 95% CI: 2.56–72.24) during 10 years of follow-up or >17 times (HR: 17.04; 95% CI: 1.80–163.39) after 5 years of follow-up.

Conclusion: Combined analysis of cystatin C and NT-proBNP could provide important prognostic information among elderly patients in the community with symptoms of HF.

Key Words: Elderly patients • Heart failure • NT-proBNP • Cystatin C • Biomarkers

Received April 14, 2008; Revised November 26, 2008; Accepted December 24, 2008


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