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Utility of Amino-Terminal Pro-Brain Natriuretic Peptide, Galectin-3, and Apelin for the Evaluation of Patients With Acute Heart Failure

Roland R. van Kimmenade, MD, PhD^_*, James L. Januzzi, Jr, MD, FACC, Patrick T. Ellinor, MD, PhD, Umesh C. Sharma, MB, BS, PhD^_*, Jaap A. Bakker, MSc, Adrian F. Low, MB, BS, Abelardo Martinez, MD, Harry J. Crijns, MD, PhD^_*, Calum A. MacRae, MB, ChB, PhD, Paul P. Menheere, PhD and Yigal M. Pinto, MD, PhD^_*,_*

^_* Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands

View larger version (24K): [in a new window]   Figure 1 Combined receiver-operating characteristic (ROC) curves for amino-terminal pro-brain natriuretic peptide (NT-proBNP), galectin (gal)-3 and apelin for the diagnosis of heart failure in dyspneic patients. The ROC analysis for NT-proBNP showed an area under the curve (AUC) for NT-proBNP of 0.94 (p < 0.0001). The ROC analysis for gal-3 showed an AUC of 0.72 (p < 0.0001). The AUC for apelin for diagnosis of acute heart failure was 0.52 (p = 0.23).

View larger version (9K): [in a new window]   Figure 2 Median galectin-3 levels among heart failure patients who died (n = 17) within 60 days and those who survived (n = 192). Boxes = interquartile ranges; whiskers = 5th and 95th percentiles.

View larger version (23K): [in a new window]   Figure 3 Combined receiver operating characteristic (ROC) curves for amino-terminal pro-brain natriuretic peptide (NT-proBNP), galectin (gal)-3 and apelin for 60-day mortality in heart failure. The ROC analysis showed an area under the curve (AUC) for gal-3 of 0.74 (p = 0.0001), an AUC for NT-proBNP of 0.67 (p = 0.009), and an AUC for apelin of 0.54 (p = 0.33).

View larger version (17K): [in a new window]   Figure 4 Kaplan-Meier analyses show that in patients with acute heart failure, at presentation the combination of a galectin-3 in excess of 9.42 ng/ml combined with amino-terminal pro-brain natriuretic peptide (NT-proBNP) above the optimal cut point (5,562 pg/ml) was associated with higher rates of death (A) or mortality/recurrent heart failure (B) than either of the 2 markers alone.