A NOVEL BIOMARKER IN ACUTE HEART FAILURE AND OBESITY PARADOX IN ACUTE MEDICAL ILLNESS

Abstract

Each year, approximately 8 million patients in the United States and 12 million patients in the European countries are hospitalized for acute medical illnesses such as heart failure, pneumonia, and stroke. VTE is an important cause of morbidity and mortality in acutely ill medical patients. Acute dyspnea is one of the most common symptoms of acutely ill patients presenting to the ER. It is a subjective symptom and often misleads the clinical diagnosis of acute heart failure. Manuscript 1 Acute dyspnea is a common symptom among emergency department (ED) patients that may be caused by both cardiac and non-cardiac diseases. Acute heart failure (HF) can be challenging to diagnose, as symptoms and signs often overlap with other conditions. The diagnosis of HF commonly relies on comprehensive analyses of medical history, symptoms, and results of echocardiography and biochemical tests. Biomarker testing and cardiac imaging studies can be helpful for reaching the correct diagnosis and subsequently guiding patient management. Insulin-like growth factor-binding protein 7 (IGFBP7), is a cell cycle arrest biomarker associated with senescence. Among patients with chronic HF, elevated concentrations of IGFBP7 predict major adverse cardiovascular events and are correlated with multiple parameters associated with impaired myocardial relaxation. The aims of the analysis were (i) to examine associations between IGFBP7 concentrations with clinically relevant characteristics and cardiac structural relationships and (ii) to evaluate whether using IGFBP7 would optimize the diagnosis of acute HF in patients presenting to the ED with acute dyspnea enrolled in the International Collaborative of N-terminal pro-B-type Natriuretic Peptide Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department (ICON-RELOADED) study. Manuscript 2 Obesity is an established risk factor for the development of many different diseases including cardiovascular and metabolic illnesses. However, there is a growing data supporting the protective effect of obesity in certain medical conditions including acute heart failure, pneumonia, acute myocardial infarction, stroke, and hospitalization for critical illnesses – the so-called “obesity paradox”. Acute illness is a hyper-catabolic state that increases the energy expenditure and requires an ample supply of calories which is stored in the adipose tissue. Impaired metabolic response to acute stress and poor nutritional reserve may adversely impact the clinical outcome. In the second analysis, we sought to investigate the association of body mass index (BMI) with venous thromboembolism (VTE) among medically ill hospitalized patients randomized in the Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial. We also tested the effect of comorbidity burden on the risk of VTE using the Charlson Comorbidity Index (CCI), a validated comorbidity assessment tool.