Clinical benefits of natriuretic peptides and galectin-3 are maintained in old dyspnoeic patients

Background: Acute dyspnoea is the leading cause of unscheduled admission of elderly patients. Several biomarkers are used to diagnose acute heart failure (AHF) and assess prognosis of dyspnoeic patients, but their value in elderly patients is unclear.

Objective: To compare diagnostic and prognostic performances of conventional and novel cardiovascular biomarkers in 2 age groups: young (<75 years old) vs. old (≥75 years old) dyspnoeic patients.

Design: Prospective observational registry.

Setting: Emergency department (ED).

Subjects: Acutely dyspnoeic adult patients.

Methods: Blood samples were collected at ED admission. The diagnostic value of 4 natriuretic peptides (BNP, proBNP, NT-proBNP, MR-proANP) for AHF was tested. We also assessed the prognostic value of same natriuretic peptides and of 3 novel cardiovascular biomarkers (galectin-3, sST2 and proenkephalin), using 1-year all-cause mortality as end-point. Diagnostic or prognostic performances are expressed as area under the receiveroperating characteristic curve (AUC) with 95% confidence interval.

Results: Two hundred one acutely dyspnoeic patients were studied. AHF was the cause of dyspnoea in 57% of old and 44% of young patients, respectively. All 4 natriuretic peptides performed well in diagnosing AHF in both age groups (all AUC>0.7). BNP showed the best diagnostic performance in both old (AUC: 0.98 [0.97-1.00]) and young (AUC 0.98 [0.95-1.00]) patients. Galectin-3 showed the best prognostic performance in both old (AUC 0.74 [0.62-0.87]) and young patients (AUC 0.75 [0.56-0.94]).

Conclusions: BNP and galectin-3 show good clinical benefits in both oldand young acutely dyspnoeic patients.