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Wong LL, Zou R, Zhou L, Lim JY, Phua DCY, Liu C, Chong JPC, Ng JYX, Liew OW, Chan SP, Chen YT, Chan MMY, Yeo PSD, Ng TP, Ling LH, Sim D, Leong KTG, Ong HY, Jaufeerally F, Wong R, Chai P, Low AF, Lund M, Devlin G, Troughton R, Cameron VA, Doughty RN, Lam CSP, Too HP, Richards AM. Combining Circulating MicroRNA and NT-proBNP to Detect and Categorize Heart Failure Subtypes. J Am Coll Cardiol 2020; 73:1300-1313. [PMID: 30898206 DOI: 10.1016/j.jacc.2018.11.060] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Clinicians need improved tools to better identify nonacute heart failure with preserved ejection fraction (HFpEF). OBJECTIVES The purpose of this study was to derive and validate circulating microRNA signatures for nonacute heart failure (HF). METHODS Discovery and validation cohorts (N = 1,710), comprised 903 HF and 807 non-HF patients from Singapore and New Zealand (NZ). MicroRNA biomarker panel discovery in a Singapore cohort (n = 546) was independently validated in a second Singapore cohort (Validation 1; n = 448) and a NZ cohort (Validation 2; n = 716). RESULTS In discovery, an 8-microRNA panel identified HF with an area under the curve (AUC) 0.96, specificity 0.88, and accuracy 0.89. Corresponding metrics were 0.88, 0.66, and 0.77 in Validation 1, and 0.87, 0.58, and 0.74 in Validation 2. Combining microRNA panels with N-terminal pro-B-type natriuretic peptide (NT-proBNP) clearly improved specificity and accuracy from AUC 0.96, specificity 0.91, and accuracy 0.90 for NT-proBNP alone to corresponding metrics of 0.99, 0.99, and 0.93 in the discovery and 0.97, 0.96, and 0.93 in Validation 1. The 8-microRNA discovery panel distinguished HFpEF from HF with reduced ejection fraction with AUC 0.81, specificity 0.66, and accuracy 0.72. Corresponding metrics were 0.65, 0.41, and 0.56 in Validation 1 and 0.65, 0.41, and 0.62 in Validation 2. For phenotype categorization, combined markers achieved AUC 0.87, specificity 0.75, and accuracy 0.77 in the discovery with corresponding metrics of 0.74, 0.59, and 0.67 in Validation 1 and 0.72, 0.52, and 0.68 in Validation 2, as compared with NT-proBNP alone of AUC 0.71, specificity 0.46, and accuracy 0.62 in the discovery; with corresponding metrics of 0.72, 0.44, and 0.57 in Validation 1 and 0.69, 0.48, and 0.66 in Validation 2. Accordingly, false negative (FN) (81% Singapore and all NZ FN cases were HFpEF) as classified by a guideline-endorsed NT-proBNP ruleout threshold, were correctly reclassified by the 8-microRNA panel in the majority (72% and 88% of FN in Singapore and NZ, respectively) of cases. CONCLUSIONS Multi-microRNA panels in combination with NT-proBNP are highly discriminatory and improved specificity and accuracy in identifying nonacute HF. These findings suggest potential utility in the identification of nonacute HF, where clinical assessment, imaging, and NT-proBNP may not be definitive, especially in HFpEF.
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Affiliation(s)
- Lee Lee Wong
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ruiyang Zou
- Bioprocessing Technology Institute, A*STAR, Singapore; MiRXES Pted Ltd, Singapore
| | - Lihan Zhou
- Bioprocessing Technology Institute, A*STAR, Singapore; MiRXES Pted Ltd, Singapore
| | - Jia Yuen Lim
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Jenny P C Chong
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jessica Y X Ng
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Oi Wah Liew
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Pang Chan
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yei-Tsung Chen
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Life Sciences and Institute of Genome Sciences National Yang-Ming University, Taipei, Taiwan
| | | | - Poh Shuan D Yeo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore; Apex Heart Clinic, Gleneagles Hospital, Singapore
| | - Tze Pin Ng
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Lieng H Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiac Department, National University Health System, Singapore
| | - David Sim
- National Heart Centre, Singhealth, Singapore
| | - Kui Toh G Leong
- Department of Cardiology, Changi General Hospital, Singapore
| | - Hean Y Ong
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - Fazlur Jaufeerally
- Duke-NUS Graduate Medical School, Singapore; Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Raymond Wong
- Cardiac Department, National University Health System, Singapore; National University Heart Centre, National University Hospital, Singapore
| | - Ping Chai
- Cardiac Department, National University Health System, Singapore; National University Heart Centre, National University Hospital, Singapore
| | - Adrian F Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiac Department, National University Health System, Singapore
| | - Mayanna Lund
- Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | | | - Richard Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Vicky A Cameron
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, Auckland, New Zealand
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Heng Phon Too
- Bioprocessing Technology Institute, A*STAR, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiac Department, National University Health System, Singapore; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
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Chan MM, Santhanakrishnan R, Chong JP, Chen Z, Tai BC, Liew OW, Ng TP, Ling LH, Sim D, Leong KTG, Yeo PSD, Ong HY, Jaufeerally F, Wong RCC, Chai P, Low AF, Richards AM, Lam CS. Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction. Eur J Heart Fail 2015; 18:81-8. [DOI: 10.1002/ejhf.431] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/23/2015] [Accepted: 09/14/2015] [Indexed: 12/16/2022] Open
Affiliation(s)
- Michelle M.Y. Chan
- SingHealth Internal Medicine Residency Program, Singapore Health Services; Singapore
| | | | - Jenny P.C. Chong
- Cardiovascular Research Institute; National University of Singapore; Singapore
| | - Zhaojin Chen
- Investigational Medicine Unit; National University Health System Singapore; Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health; National University of Singapore; Singapore
| | - Oi Wah Liew
- Cardiovascular Research Institute; National University of Singapore; Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Lieng H. Ling
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - David Sim
- National Heart Centre Singapore; Singapore
| | | | | | | | - Fazlur Jaufeerally
- Singapore General Hospital and Duke-NUS Graduate Medical School; Singapore
| | | | - Ping Chai
- National University Heart Centre Singapore; Singapore
| | - Adrian F. Low
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Arthur M. Richards
- Cardiovascular Research Institute; National University of Singapore; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Carolyn S.P. Lam
- Cardiovascular Research Institute; National University of Singapore; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
- Christchurch Heart Institute, University of Otago; Christchurch New Zealand
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Wong LL, Armugam A, Sepramaniam S, Karolina DS, Lim KY, Lim JY, Chong JPC, Ng JYX, Chen YT, Chan MMY, Chen Z, Yeo PSD, Ng TP, Ling LH, Sim D, Leong KTG, Ong HY, Jaufeerally F, Wong R, Chai P, Low AF, Lam CSP, Jeyaseelan K, Richards AM. Circulating microRNAs in heart failure with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 2015; 17:393-404. [PMID: 25619197 DOI: 10.1002/ejhf.223] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/11/2014] [Accepted: 11/14/2014] [Indexed: 01/15/2023] Open
Abstract
AIM The potential diagnostic utility of circulating microRNAs in heart failure (HF) or in distinguishing HF with reduced vs. preserved left ventricular ejection fraction (HFREF and HFPEF, respectively) is unclear. We sought to identify microRNAs suitable for diagnosis of HF and for distinguishing both HFREF and HFPEF from non-HF controls and HFREF from HFPEF. METHODS AND RESULTS MicroRNA profiling performed on whole blood and corresponding plasma samples of 28 controls, 39 HFREF and 19 HFPEF identified 344 microRNAs to be dysregulated among the three groups. Further analysis using an independent cohort of 30 controls, 30 HFREF and 30 HFPEF, presented 12 microRNAs with diagnostic potential for one or both HF phenotypes. Of these, miR-1233, -183-3p, -190a, -193b-3p, -193b-5p, -211-5p, -494, and -671-5p distinguished HF from controls. Altered levels of miR-125a-5p, -183-3p, -193b-3p, -211-5p, -494, -638, and -671-5p were found in HFREF while levels of miR-1233, -183-3p, -190a, -193b-3p, -193b-5p, and -545-5p distinguished HFPEF from controls. Four microRNAs (miR-125a-5p, -190a, -550a-5p, and -638) distinguished HFREF from HFPEF. Selective microRNA panels showed stronger discriminative power than N-terminal pro-brain natriuretic peptide (NT-proBNP). In addition, individual or multiple microRNAs used in combination with NT-proBNP increased NT-proBNP's discriminative performance, achieving perfect intergroup distinction. Pathway analysis revealed that the altered microRNAs expression was associated with several mechanisms of potential significance in HF. CONCLUSIONS We report specific microRNAs as potential biomarkers in distinguishing HF from non-HF controls and in differentiating between HFREF and HFPEF.
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Affiliation(s)
- Lee Lee Wong
- Cardiovascular Research Institute, Singapore; Department of Medicine, Singapore
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Santhanakrishnan R, Chong JPC, Ng TP, Ling LH, Sim D, Leong KTG, Yeo PSD, Ong HY, Jaufeerally F, Wong R, Chai P, Low AF, Richards AM, Lam CSP. Growth differentiation factor 15, ST2, high-sensitivity troponin T, and N-terminal pro brain natriuretic peptide in heart failure with preserved vs. reduced ejection fraction. Eur J Heart Fail 2012; 14:1338-47. [PMID: 22869458 DOI: 10.1093/eurjhf/hfs130] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Growth differentiation factor 15 (GDF15), ST2, high-sensitivity troponin T (hsTnT), and N-terminal pro brain natriuretic peptide (NT-proBNP) are biomarkers of distinct mechanisms that may contribute to the pathophysiology of heart failure (HF) [inflammation (GDF15); ventricular remodelling (ST2); myonecrosis (hsTnT); and wall stress (NT-proBNP)]. METHODS AND RESULTS We compared circulating levels of GDF15, ST2, hsTnT, and NT-proBNP, as well as their combinations, in compensated patients with clinical HF with reduced ejection fraction (HFREF) (n = 51), HF with preserved ejection fraction (HFPEF) (n= 50), and community-based controls (n = 50). Compared with controls, patients with HFPEF and HFREF had higher median levels of GDF15 (540 pg/mL vs. 2529 and 2672 pg/mL, respectively), hsTnT (3.7 pg/mL vs. 23.7 and 35.6 pg/mL), and NT-proBNP (69 pg/mL vs. 942 and 2562 pg/mL), but not ST2 (27.6 ng/mL vs. 31.5 and 35.3 ng/mL), adjusting for clinical covariates. In receiver operating characteristic curve analyses, NT-proBNP distinguished HFREF from controls with an area under the curve (AUC) of 0.987 (P < 0.001); GDF15 distinguished HFPEF from controls with an AUC of 0.936 (P < 0.001); and the combination of NT-proBNP and GDF15 distinguished HFPEF from controls with an AUC of 0.956 (P < 0.001). NT-proBNP and hsTnT levels were higher in HFREF than in HFPEF (adjusted P < 0.04). The NT-proBNP:GDF15 ratio distinguished between HFPEF and HFREF with the largest AUC (0.709; P < 0.001). CONCLUSIONS Our study provides comparative data on physiologically distinct circulating biomarkers in HFPEF, HFREF, and controls from the same community. These data suggest a prominent role for myocardial injury (hsTnT) with increased wall stress (NT-proBNP) in HFREF, and systemic inflammation (GDF15) in HFPEF.
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Leong KTG, Goh PP, Chang BC, Lingamanaicker J. Heart failure cohort in Singapore with defined criteria: clinical characteristics and prognosis in a multi-ethnic hospital-based cohort in Singapore. Singapore Med J 2007; 48:408-14. [PMID: 17453098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION There are limited data on heart failure (HF) cohorts with objective clinical definition of HF. Many observational HF studies were based on discharge diagnosis codes, making them subjective. Many did not have contemporaneous left ventricular function assessment. This study was done to evaluate the characteristics and one-year prognosis of a single centre multi-ethnic Asian inpatient HF cohort, with these limitations addressed, with the aim of yielding a more accurate picture of true HF. METHODS This was an observational prospective study. Patients who fulfilled the modified Framingham criteria for clinical HF and study inclusion criteria of serum creatinine level less than 267 micromol/L, serum albumin level greater than 28 g/L, and a contemporaneous trans-thoracic echocardiography (TTE) study were enrolled. TTE studies ordered were attempted within 72 hours. RESULTS 173 patients were enrolled into the study. TTE was done within 72 hours of admission for 86.1 percent (n = 149) of the participants. Diastolic HF constituted 22.0 percent of the cohort. The mean age of the participants was 68.7 (standard deviation, 12.0) years. The prevalence of elderly patients, diabetes mellitus, hypertension and ischaemic cardiomyopathy were high. The one-year mortality rate was 20.8 percent (n = 36). The one-year death or readmission for any cause rate was 69.4 percent (n = 120). The mean time in hospital for any cause within the one year was 11.8 +/- 17.9 days. Ethnicity had prognostic implications. Being elderly, having elevated random blood glucose or serum creatinine levels were associated with a worse prognosis. CONCLUSION With strict methodology, HF is truly a disease of the elderly, with significant one-year mortality and morbidity consequences. Prognostic characteristics are reviewed.
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Affiliation(s)
- K T G Leong
- Division of Cardiology, Changi General Hospital, Singapore 529889.
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