OBJECTIVES This study examined whether insulin-like growth factor binding protein-7 (IGFBP7) would aid in the diagnosis and prognosis of acute heart failure (HF) beyond N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration. BACKGROUND IGFBP7 is associated with impaired ventricular relaxation and worse prognosis. METHODS The ICON-RELOADED (International Collaborative of NT-proBNP-Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department) study was a prospective, multicenter clinical trial that enrolled subjects presenting with dyspnea. Six-month prognosis for death or repeat hospitalization was obtained. RESULTS Among 1,449 patients, 274 (18.9%) were diagnosed with acute HF. Those with IGFBP7 concentrations in the highest quartile were older, male, had hypertension and HF, had lower estimated glomerular filtration rate (eGFR) and lowest ejection fraction (41 ± 20%; all p < 0.001). Independent predictors of IGFBP7 were age, male sex, history of diabetes, history of HF, and eGFR. Median concentrations of NT-proBNP (2,844 ng/ml vs. 99 ng/ml) and IGFBP7 (146.1 ng/ml vs. 86.1 ng/ml) were higher in those with acute HF (both; p < 0.001). Addition of IGFBP7 to NT-proBNP concentrations improved discrimination, therefore increasing the area under the receiver operating curve for diagnosis of acute HF (from 0.91 to 0.94; p < 0.001 for differences). Addition of IGFBP7 to a complete model of independent predictors of acute HF improved model calibration. IGFBP7 significantly reclassified acute HF diagnosis beyond NT-proBNP (net reclassification index: +0.25). Higher log2-IGFBP7 concentrations in patients with acute HF predicted death or rehospitalization at 6 months (hazard ratio: 1.84 per log2-SD; 95% confidence interval: 1.30 to 2.61; p = 0.001). In Kaplan-Meier analyses, supramedian concentrations of IGFBP7 were associated with shorter event-free survival (log-rank: p < 0.001). CONCLUSIONS Among patients with acute dyspnea, concentrations of IGFBP7 add to NT-proBNP for diagnosis of acute HF and provide added prognostic utility for short-term risk.

中文翻译：

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胰岛素样生长因子结合蛋白-7在呼吸困难患者中的诊断和预后作用。

目的这项研究检查了胰岛素样生长因子结合蛋白7（IGFBP7）是否有助于诊断和预后超过N端前B型利尿钠肽（NT-proBNP）浓度的急性心力衰竭（HF）。背景技术IGFBP7与心室舒张受损和预后不良有关。方法ICON-RELOADED（NT-proBNP-急诊科对急性诊断临界值的重新评估的国际合作）研究是一项前瞻性，多中心临床试验，纳入了呼吸困难的受试者。获得了六个月的死亡或再次住院的预后。结果在1,449名患者中，有274名（18.9％）被诊断出患有急性心力衰竭。IGFBP7浓度最高的人群中，年龄较大，男性，患有高血压和HF，具有较低的估计肾小球滤过率（eGFR）和最低的射血分数（41±20％；所有p <0.001）。IGFBP7的独立预测因子是年龄，男性，糖尿病史，HF史和eGFR。急性心力衰竭者中NT-proBNP的中位浓度（2,844 ng / ml对99 ng / ml）和IGFBP7（146.1 ng / ml对86.1 ng / ml）更高（均p <0.001）。将IGFBP7添加到NT-proBNP浓度可改善分辨力，因此增加了诊断急性HF的接受者操作曲线下的面积（从0.91到0.94；差异p <0.001）。将IGFBP7添加到急性HF独立预测因子的完整模型中可改善模型校准。IGFBP7显着地将急性HF诊断重新分类，超过了NT-proBNP（净重新分类指数：+0.25）。急性HF患者中较高的log2-IGFBP7浓度可预测6个月时死亡或再次住院（危险比：每个log2-SD为1.84； 95％置信区间：1.30至2.61； p = 0.001）。在Kaplan-Meier分析中，超胰岛素浓度的IGFBP7与较短的无事件生存期相关（log-rank：p <0.001）。结论在急性呼吸困难患者中，IGFBP7的浓度增加到NT-proBNP中以诊断急性HF，并为短期风险提供了更多的预后效用。