Additive prognostic value of cardiac biomarkers in patients with chronic obstructive pulmonary disease and heart failure

Background

Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). We assessed the influence of COPD on circulating levels and prognostic value of 3 HF biomarkers: N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and soluble suppression of tumorigenesis-2 (sST2).

Methods

Individual data from patients with chronic HF, known COPD status and NT-proBNP, hs-TnT, sST2 values (n=13328) were analysed.

Results

As compared to patients without COPD, those with COPD (n=2155, 16%) were older (age 71 years [64–77] vs. 66 [57–75]; p<0.001), more frequently men (79% vs. 74%; p<0.001), had more severe dyspnoea (43% in New York Heart Association [NYHA] class III-IV vs. 31%; p<0.001), slightly worse renal function (median estimated glomerular filtration rate [eGFR] 58 mL/min/1.73 m2 [43–73] vs. 60 [46–77]; p<0.001), higher NT-proBNP (1508 ng/L [650–3363] vs. 1239 ng/L [479–2911]; p<0.001), hs-TnT (22 ng/L [13–38] vs. 17 ng/L [9–30]; p<0.001), and sST2 (31 ng/mL [23–45] vs. 29 [21–43]; p=0.040). In both the COPD and no-COPD subgroups, the best cut-offs of the 3 biomarkers refined the prediction of 1- and 5-year all-cause and cardiovascular mortality and 1- to 12-month HF hospitalization over a prognostic model including age, sex, ischemic aetiology, eGFR, HF categories, NYHA III-IV, beta-blocker use and the NT-proBNP cut-off alone.

Conclusions

Among patients with HF, those with COPD have higher circulating cardiac biomarkers. Patient classification based on COPD-specific cut-offs refines risk reclassification for all-cause and cardiovascular mortality and HF hospitalization and might be helpful for decision making and management.

Funding Acknowledgement

Type of funding sources: None.

Chronic obstructive pulmonary disease in heart failure: influence on circulating biomarkers and outcome

Background

Chronic obstructive pulmonary disease (COPD) is common in patients with chronic heart failure (CHF).

Purpose

We aimed to explore the impact of COPD on HF biomarkers (N-terminal fraction of pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T [hs-TnT], and soluble suppression of tumorigenesis-2 [sST2]) and outcome.

Methods

Individual data from 14 cohorts of patients with stable chronic HF and NT-proBNP and hs-TnT values were analysed. Patients with known COPD status were evaluated.

Results

Patients (n=13,178) were aged 67 years (58–75), 75% males, and 76%, 11%, 13% with HF with reduced, mid-range, or preserved ejection fraction (HFrEF/HFmrEF/HFpEF), respectively. Patients with COPD were older than those without COPD (age 71 years [64–77] vs. 66 [57–75]; p<0.001), more frequently males (79% vs. 74%; p<0.001), had more often ischaemic HF (54% vs. 52%; p<0.001), and HFpEF (14% vs. 12%; p=0.011), but not HFpEF (12% vs. 11%; p=0.097). COPD patients had also more severe dyspnoea (44% in NYHA class III-IV vs. 31%; p<0.001), and slightly worse renal function (median estimated glomerular filtration rate [eGFR] 58 mL/min/1.73 m2 [44–74] vs. 60 [46–67]; p<0.001). Patients with COPD had higher NT-proBNP (1501 ng/L [642–3333] vs. 1225 ng/L [476–2902]; p<0.001), hs-TnT (22 ng/L [13–38] vs. 17 ng/L [9–30]; p<0.001), and sST2 (30 ng/mL [22–45] vs. 29 [21–43]; p<0.001).

Over a median follow-up of 2.1 years (1.5–3.7, range 0–18 years), 3,865/12,489 patients (31%) died; among them, 2,443/12,450 (20%) died for cardiovascular causes; 3,373/12,469 patients (27%) were hospitalized for HF over 35 months (15–63, range 0–216 months). Patients with COPD had a significantly higher all-cause mortality, cardiovascular mortality, and worse survival free from HF hospitalization (all p<0.001; Figure). In a model including age, gender, ischaemic vs. non-ischaemic aetiology, eGFR, HFrEF/HFmrEF/HFpEF, and NYHA class III-IV, COPD retained independent prognostic significance from NT-proBNP for 1-year all-cause (p=0.009) and cardiovascular mortality (p=0.022), 5-year all-cause (p<0.001) and cardiovascular mortality (p=0.011) as well as 3- (p=0.033), 6- (p=0.019) and 12-month HF hospitalization (p=0.033). COPD lost its independent prognostic significance when hs-TnT and sST2 were included in the model.

Conclusions

COPD in HF is characterized by higher NT-proBNP, hs-TnT and sST2 levels. COPD adds prognostic significance over NT-proBNP alone, but not over the combination of NT-proBNP, hs-TnT, and sST2.

Funding Acknowledgement

Type of funding source: None