Vol 20, No 2 (2013)
Original articles
Published online: 2013-04-05
Serum biomarkers and clinical outcomes in heart failure patients treated de novo with carvedilol
DOI: 10.5603/CJ.2013.0027
Cardiol J 2013;20(2):144-151.
Abstract
Background: The role of infl ammatory and hemodynamic stress biomarkers in heart failure
(HF) patients treated de novo with beta-blockers has been poorly studied.
Methods: A total of 86 patients (age 56 ± 9 years, 81 men) with left ventricular ejection fraction
(LVEF) < 40% and previously not treated with beta-blockers were initiated on carvedilol.
At baseline and 12 months later we performed echocardiography, cardiopulmonary exercise
testing, and determined serum levels of B-type natriuretic peptide (BNP), endothelin-1 (ET-1),
C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNF -a). Patients
were followed up over a total period of 9 ± 3 years from baseline.
Results: Increased baseline CRP and its on-treatment decrease were associated with improvement
of LVEF (est. coeffi cient per one SD: 1.6; 95% CI: –0.05,3.28; p = 0.056, and –1.80;
–3.43, –0.18; p = 0.030, respectively) and diminishing of LV end-systolic volume index
[mL/m2] (–6.83; –11.32; –2.34; p = 0.003, and 5.85; 1.23; –10.46; p = 0.014, respectively).
Higher baseline ET-1 and on-treatment increase in TNF-a predicted frequent admissions
(> 1) for cardiac complications (odds ratio per one SD: 1.98; 95% CI: 1.09–3.59;
p = 0.025, and 2.07, 1.12–3.84, p = 0.021, respectively) whereas higher baseline BNP was
asociated with increased mortality (hazard ratio per one SD: 2.09, 95% CI: 1.26–3.45;
p = 0.004).
Conclusions: Serum biomarkers may have different roles in prediction of clinical outcomes
among HF patients treated de novo with carvedilol.
(HF) patients treated de novo with beta-blockers has been poorly studied.
Methods: A total of 86 patients (age 56 ± 9 years, 81 men) with left ventricular ejection fraction
(LVEF) < 40% and previously not treated with beta-blockers were initiated on carvedilol.
At baseline and 12 months later we performed echocardiography, cardiopulmonary exercise
testing, and determined serum levels of B-type natriuretic peptide (BNP), endothelin-1 (ET-1),
C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNF -a). Patients
were followed up over a total period of 9 ± 3 years from baseline.
Results: Increased baseline CRP and its on-treatment decrease were associated with improvement
of LVEF (est. coeffi cient per one SD: 1.6; 95% CI: –0.05,3.28; p = 0.056, and –1.80;
–3.43, –0.18; p = 0.030, respectively) and diminishing of LV end-systolic volume index
[mL/m2] (–6.83; –11.32; –2.34; p = 0.003, and 5.85; 1.23; –10.46; p = 0.014, respectively).
Higher baseline ET-1 and on-treatment increase in TNF-a predicted frequent admissions
(> 1) for cardiac complications (odds ratio per one SD: 1.98; 95% CI: 1.09–3.59;
p = 0.025, and 2.07, 1.12–3.84, p = 0.021, respectively) whereas higher baseline BNP was
asociated with increased mortality (hazard ratio per one SD: 2.09, 95% CI: 1.26–3.45;
p = 0.004).
Conclusions: Serum biomarkers may have different roles in prediction of clinical outcomes
among HF patients treated de novo with carvedilol.
Keywords: heart failurebeta-blockerbiological markersnatriuretic peptidesendothelin-1C-reactive protein
