Predictors of acute heart failure decompensation development in patients with prediabetes: Diagnostic value of adrenomedullin and cancer antigen 125
Abstract. The role of prediabetes in the context of acute decompensated heart failure (ADHF) has not been found yet.S.V. Mironova, E.V. Ulybina, N.A. Koziolova
The aim: to identify predictors of ADHF development in patients with prediabetes and to evaluate the diagnostic value of proadrenomedullin N-terminal peptide (20 amino acids) (PAMP) and cancer antigen 125 (CA-125) biomarkers in the blood, including at low levels of N-terminal brain natriuretic peptide (NT-proBNP).
Material and methods. 123 patients with ADHF were consecutively enrolled in the study over a 36-month period. Participants were divided into two groups: the first group included 66 (53.7%) patients with ADHF without prediabetes, and the second included 57 (46.3%) patients with ADHF and prediabetes. During the first 48 hours, patients underwent echocardiography, NT-proBNP, CA-125, PAMP, cystatin C levels, and volumetric sphygmoplethysmography.
Results. In the group of patients with prediabetes, body mass index > 30 kg/m2 and triglyceride-glucose index >9 increased the relative risk (RR) of ADHF developing by 2.4 and 2.6 times, respectively. Moderately reduced ejection fraction, diastolic dysfunction and left ventricular hypertrophy, increased indexed left atrial volume, estimated glomerular filtration rate < 60 ml/min/1.73m2 and aortic pulse wave velocity >6 increased the OR of ADHF developing in patients with prediabetes by 1.7, 1.8, 1.5, 1.7, 1.8 and 1.5 times, respectively. NT-proBNP values < 300 pg/ml were detected in 21.1% of patients with ADHF. ROC analysis showed that CA-125 levels > 12.037 KEU/mL and PAMP > 31.6 pg/mL can be considered as diagnostic criteria for ADHF in patients with prediabetes. Using these criteria comparatively to NT-proBNP > 300 pg/mL increased the OR for ADHF verification, regardless of glycemic status.
Conclusion. Metabolic risk factors for carbohydrate metabolism disorders, cardiac remodeling, renal dysfunction, and increased arterial stiffness were perceived as predictors of ADHF development in patients with prediabetes. Determination of CA-125 and PAMP biomarkers in the blood of patients with suspected ADHF has a higher diagnostic value than NT-proBNP, including at low values of NT-proBNP.
Keywords
acute decompensated heart failure
prediabetes
cancer antigen 125
adrenomedullin
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About the Authors
Snezhana V. Mironova, MD, PhD (Medicine), associate professor of the Department of internal medicine and cardiology, E.A. Wagner Perm State Medical University, Perm, Russian Federation.E-mail: sv.mironova.2017@yandex.ru
ORCID: https://orcid.org/0000-0002-1788-4282. eLibrary SPIN: 9134-7229
Elizaveta V. Ulybina, MD, postgraduate student of the Department of internal medicine and cardiology, E.A. Wagner Perm State Medical University, Perm, Russian Federation.
E-mail: laulybina@yandex.ru
ORCID: https://orcid.org/0000-0001-5480-2736. eLibrary SPIN: 6898-4085
Natalia A. Koziolova, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine and cardiology, E.A. Wagner Perm State Medical University, Perm, Russian Federation.
E-mail: nakoziolova@mail.ru
ORCID: https://orcid.org/0000-0001-7003-5186. eLibrary SPIN: 1044-0503
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