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Kalayci A, Peacock WF, Nagurney JT, Hollander JE, Levy PD, Singer AJ, Shapiro NI, Cheng RK, Cannon CM, Blomkalns AL, Walters EL, Christenson RH, Chen-Tournoux A, Nowak RM, Lurie MD, Pang PS, Kastner P, Masson S, Gibson CM, Gaggin HK, Januzzi JL. Echocardiographic assessment of insulin-like growth factor binding protein-7 and early identification of acute heart failure. ESC Heart Fail 2020; 7:1664-1675. [PMID: 32406612 PMCID: PMC7373911 DOI: 10.1002/ehf2.12722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022] Open
Abstract
Aims Concentrations of insulin‐like growth factor binding protein‐7 (IGFBP7) have been linked to abnormal cardiac structure and function in patients with chronic heart failure (HF), but cardiovascular correlates of the biomarker in patients with more acute presentations are lacking. We aimed to determine the relationship between IGFBP7 concentrations and cardiac structure and to evaluate the impact of IGFBP7 on the diagnosis of acute HF among patients with acute dyspnoea. Methods and results In this pre‐specified subgroup analysis of the International Collaborative of N‐terminal pro‐B‐type Natriuretic Peptide Re‐evaluation of Acute Diagnostic Cut‐Offs in the Emergency Department (ICON‐RELOADED) study, we included 271 patients with and without acute HF. All patients presented to an emergency department with acute dyspnoea, had blood samples for IGFBP7 measurement, and detailed echocardiographic evaluation. Higher IGFBP7 concentrations were associated with numerous cardiac abnormalities, including increased left atrial volume index (LAVi; r = 0.49, P < 0.001), lower left ventricular ejection fraction (r = −0.27, P < 0.001), lower right ventricular fractional area change (r = −0.31, P < 0.001), and higher tissue Doppler E/e′ ratio (r = 0.44, P < 0.001). In multivariable linear regression analyses, increased LAVi (P = 0.01), lower estimated glomerular filtration rate (P = 0.008), higher body mass index (P = 0.001), diabetes (P = 0.009), and higher concentrations of amino‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP, P = 0.02) were independently associated with higher IGFBP7 concentrations regardless of other variables. Furthermore, IGFBP7 (odds ratio = 12.08, 95% confidence interval 2.42–60.15, P = 0.02) was found to be independently associated with the diagnosis of acute HF in the multivariable logistic regression analysis. Conclusions Among acute dyspnoeic patients with and without acute HF, increased IGFBP7 concentrations are associated with a range of cardiac structure and function abnormalities. Independent association with increased LAVi suggests elevated left ventricular filling pressure is an important trigger for IGFBP7 expression and release. IGFBP7 may enhance the diagnosis of acute HF.
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Affiliation(s)
- Arzu Kalayci
- Baim Institute for Clinical Research, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Phillip D Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andra L Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth L Walters
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Annabel Chen-Tournoux
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Richard M Nowak
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Mark D Lurie
- Division of Cardiology, Torrance Memorial Medical Center, Torrance, CA, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine & Indianapolis EMS, Indianapolis, Indiana, USA
| | | | - Serge Masson
- Roche Diagnostics International, Rotkreuz, Switzerland
| | - C Michael Gibson
- Baim Institute for Clinical Research, Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hanna K Gaggin
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, MA, 02114, USA
| | - James L Januzzi
- Baim Institute for Clinical Research, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
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