Comparative assessment of short-termadverse events in acute heart failure withcystatin C and other estimates of renal function: Results from the ASCEND-HF trial

W. H Wilson Tang, Matthias Dupont, Adrian F. Hernandez, Adriaan A. Voors, Amy P. Hsu, G. Michael elker, Javed Butler, Marco Metra, Stefan D. Anker, Richard W. Troughton, Stephen S. Gottlieb, John J. McMurray, Paul W. Armstrong, Barry M. Massie, Robert M. Califf, Christopher M. O'Connor, Randall C. Starling

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C (CysC) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acutedecompensated heart failure (ADHF). Background: Newer renal biomarkers or their derived estimates of renal function have demonstrated long-term prognostic value in chronic heart failure. Methods: CysC levels were measured in sequential plasma samples from 811 subjects with ADHF who were enrolled in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) biomarker sub-study (randomized to nesiritide therapy vs. placebo), and followed for all-cause death (180 days) and recurrent hospital stay (30 days). Results: Median CysC levels were 1.49 (interquartile range [IQR]: 1.20 to 1.96) mg/l at baseline, 1.56 (IQR: 1.28 to 2.13) mg/lat 48 to 72 h, and 1.58 (IQR: 1.24 to 2.11) mg/l at 30 days. Higher baseline (but not follow-up) CysC levels were associated with increased risk of 30-day adverse events and less improvement in dyspnea after 24 h as well as 180-day mortality, although not incremental to blood urea nitrogen. Worsening renal function (defined as a 0.3 mg/l increase in CysC) occurred in 161 of 701 (23%) patients, but it was not predictive of adverse events. Changes in CysC levels were similar between the nesiritide and placebo groups. Conclusions: Our findings confirmed the prognostic value of baseline CysC levels in the setting of ADHF. However, worsening renal function based on CysC rise was not predictive of adverse events. Nesiritide did not worsen renal function compared with placebo.

Original languageEnglish
Pages (from-to)40-49
Number of pages10
JournalJACC: Heart Failure
Volume3
Issue number1
DOIs
Publication statusPublished - Jan 1 2015

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Cystatin C
Brain Natriuretic Peptide
Heart Failure
Kidney
Placebos
Biomarkers
Blood Urea Nitrogen
Dyspnea
Cause of Death
Length of Stay

Keywords

  • Acute heart failure
  • Cystatin C
  • Nesiritide
  • Renal insufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Comparative assessment of short-termadverse events in acute heart failure withcystatin C and other estimates of renal function : Results from the ASCEND-HF trial. / Tang, W. H Wilson; Dupont, Matthias; Hernandez, Adrian F.; Voors, Adriaan A.; Hsu, Amy P.; elker, G. Michael; Butler, Javed; Metra, Marco; Anker, Stefan D.; Troughton, Richard W.; Gottlieb, Stephen S.; McMurray, John J.; Armstrong, Paul W.; Massie, Barry M.; Califf, Robert M.; O'Connor, Christopher M.; Starling, Randall C.

In: JACC: Heart Failure, Vol. 3, No. 1, 01.01.2015, p. 40-49.

Research output: Contribution to journalArticle

Tang, WHW, Dupont, M, Hernandez, AF, Voors, AA, Hsu, AP, elker, GM, Butler, J, Metra, M, Anker, SD, Troughton, RW, Gottlieb, SS, McMurray, JJ, Armstrong, PW, Massie, BM, Califf, RM, O'Connor, CM & Starling, RC 2015, 'Comparative assessment of short-termadverse events in acute heart failure withcystatin C and other estimates of renal function: Results from the ASCEND-HF trial', JACC: Heart Failure, vol. 3, no. 1, pp. 40-49. https://doi.org/10.1016/j.jchf.2014.06.014
Tang, W. H Wilson ; Dupont, Matthias ; Hernandez, Adrian F. ; Voors, Adriaan A. ; Hsu, Amy P. ; elker, G. Michael ; Butler, Javed ; Metra, Marco ; Anker, Stefan D. ; Troughton, Richard W. ; Gottlieb, Stephen S. ; McMurray, John J. ; Armstrong, Paul W. ; Massie, Barry M. ; Califf, Robert M. ; O'Connor, Christopher M. ; Starling, Randall C. / Comparative assessment of short-termadverse events in acute heart failure withcystatin C and other estimates of renal function : Results from the ASCEND-HF trial. In: JACC: Heart Failure. 2015 ; Vol. 3, No. 1. pp. 40-49.
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abstract = "Objectives: The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C (CysC) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acutedecompensated heart failure (ADHF). Background: Newer renal biomarkers or their derived estimates of renal function have demonstrated long-term prognostic value in chronic heart failure. Methods: CysC levels were measured in sequential plasma samples from 811 subjects with ADHF who were enrolled in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) biomarker sub-study (randomized to nesiritide therapy vs. placebo), and followed for all-cause death (180 days) and recurrent hospital stay (30 days). Results: Median CysC levels were 1.49 (interquartile range [IQR]: 1.20 to 1.96) mg/l at baseline, 1.56 (IQR: 1.28 to 2.13) mg/lat 48 to 72 h, and 1.58 (IQR: 1.24 to 2.11) mg/l at 30 days. Higher baseline (but not follow-up) CysC levels were associated with increased risk of 30-day adverse events and less improvement in dyspnea after 24 h as well as 180-day mortality, although not incremental to blood urea nitrogen. Worsening renal function (defined as a 0.3 mg/l increase in CysC) occurred in 161 of 701 (23{\%}) patients, but it was not predictive of adverse events. Changes in CysC levels were similar between the nesiritide and placebo groups. Conclusions: Our findings confirmed the prognostic value of baseline CysC levels in the setting of ADHF. However, worsening renal function based on CysC rise was not predictive of adverse events. Nesiritide did not worsen renal function compared with placebo.",
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T2 - Results from the ASCEND-HF trial

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AU - Dupont, Matthias

AU - Hernandez, Adrian F.

AU - Voors, Adriaan A.

AU - Hsu, Amy P.

AU - elker, G. Michael

AU - Butler, Javed

AU - Metra, Marco

AU - Anker, Stefan D.

AU - Troughton, Richard W.

AU - Gottlieb, Stephen S.

AU - McMurray, John J.

AU - Armstrong, Paul W.

AU - Massie, Barry M.

AU - Califf, Robert M.

AU - O'Connor, Christopher M.

AU - Starling, Randall C.

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N2 - Objectives: The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C (CysC) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acutedecompensated heart failure (ADHF). Background: Newer renal biomarkers or their derived estimates of renal function have demonstrated long-term prognostic value in chronic heart failure. Methods: CysC levels were measured in sequential plasma samples from 811 subjects with ADHF who were enrolled in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) biomarker sub-study (randomized to nesiritide therapy vs. placebo), and followed for all-cause death (180 days) and recurrent hospital stay (30 days). Results: Median CysC levels were 1.49 (interquartile range [IQR]: 1.20 to 1.96) mg/l at baseline, 1.56 (IQR: 1.28 to 2.13) mg/lat 48 to 72 h, and 1.58 (IQR: 1.24 to 2.11) mg/l at 30 days. Higher baseline (but not follow-up) CysC levels were associated with increased risk of 30-day adverse events and less improvement in dyspnea after 24 h as well as 180-day mortality, although not incremental to blood urea nitrogen. Worsening renal function (defined as a 0.3 mg/l increase in CysC) occurred in 161 of 701 (23%) patients, but it was not predictive of adverse events. Changes in CysC levels were similar between the nesiritide and placebo groups. Conclusions: Our findings confirmed the prognostic value of baseline CysC levels in the setting of ADHF. However, worsening renal function based on CysC rise was not predictive of adverse events. Nesiritide did not worsen renal function compared with placebo.

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KW - Acute heart failure

KW - Cystatin C

KW - Nesiritide

KW - Renal insufficiency

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