Biomarkers in Acute Heart Failure
- Conditions
- Shortness of BreathHeart Failure
- Registration Number
- NCT00537628
- Lead Sponsor
- Brahms AG
- Brief Summary
Primary Objectives
1. Mid Region pro Adrenomedullin (MR-proADM) is superior to BNP for the prognosis of heart failure (HF) patients and adds incremental value in predicting outcomes for patients presenting to the Emergency Department (ED) with shortness of breath.
2. Mid Region pro A-Type Natriuretic Peptide (MR-proANP) is non-inferior to BNP for the diagnosis of HF in patients presenting to the ED with shortness of breath.
- Detailed Description
The diagnosis of heart failure is often very difficult. Clinical history is often vague, and physical examination findings suffer from lack of specificity and sensitivity. For example, symptoms like shortness of breath and edema are often present in patients without cardiac disease, while elevated jugular venous pressure can be difficult to visualize and auscultation of a third heart sound can be challenging to hear, especially in an emergency room setting.
Although BNP levels can sometimes help clarify the clinical picture when patients present acutely with shortness of breath, patients both with and without heart failure may have BNP values that fall into a "gray zone", where the diagnosis is still very much in question. Also, there can be difficulties in interpreting BNP levels in patients with renal dysfunction, patients with a high body mass index, and patients of advanced age.
Investigative tests in the emergency department such as the electrocardiogram or chest x-ray are also non-specific for diagnosing heart failure. Tests such as echocardiography, while accurate in the assessment of left ventricular dysfunction, are expensive and are not always available on an emergent basis; furthermore, the presence of heart failure with normal systolic function (a.k.a. diastolic dysfunction) can complicate the interpretation of echocardiograms. Additionally, just because a patient has systolic dysfunction on an urgent echocardiogram does not mean that their acute dyspnea is due to heart failure, and so the test itself may not accurately reflect the acute situation at hand.
Another difficult diagnostic dilemma arises when a patient with a history of heart failure presents with signs that could also be consistent an acute respiratory illness such as pneumonia. Often, patients with background heart failure have elevated BNP levels at baseline. In this setting, chest radiographs can be especially difficult to interpret when one must distinguish between edema and infiltrates, or possibly both.
For all of these reasons, there is a pressing need for additional tools to help us differentiate heart failure from other causes of dyspnea in our acutely short of breath patients, and to improve our ability to provide accurate prognostic information and sound therapeutic management to our heart failure patients.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1641
- Eighteen years of age or older.
- The patients must be seen in the urgent care or emergency area with a chief complaint of shortness of breath not due to trauma.
- Patient is unable to sign or understand the consent form.
- Patient is on any dialysis.
- Patient has trauma related shortness of breath (i.e. penetrating wounds, crush injury).
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (15)
University of California, San Diego
🇺🇸San Diego, California, United States
Veterans Affairs Medical Center
🇺🇸San Diego, California, United States
University of California, San Francisco
🇺🇸San Francisco, California, United States
University of Maryland
🇺🇸Baltimore, Maryland, United States
Henry Ford Health System
🇺🇸Detroit, Michigan, United States
Athens University Hospital Attikon
🇬🇷Athens, Greece
University La Sapienza
🇮🇹Rome, Italy
University of Minnesota
🇺🇸Minneapolis, Minnesota, United States
Virgina Commonwealth University
🇺🇸Richmond, Virginia, United States
The Cleveland Clinic
🇺🇸Cleveland, Ohio, United States
Charite- Universitatsmedizin Berlin
🇩🇪Berlin, Germany
University of Otago
🇳🇿Christchurch, New Zealand
Clinical Military Hospital
🇵🇱Wroclaw, Poland
University Hospital Basel
🇨🇭Basel, Switzerland
University of Leicester
🇬🇧Leicester, United Kingdom