Background: B-type natriuretic peptide (BNP) levels are useful in the diagnosis of heart
failure (HF) in patients with acute dyspnea, but their diagnostic value is confounded by
age. We examined the impact of age on the levels and utility of novel cardiac biomarkers
in a secondary analysis of the Biomarkers in ACute Heart Failure (BACH) study.
Methods: The BACH study was a multinational 15-center prospective study of the use of
novel cardiovascular prohormone fragments in diagnosing HF among dyspneic patients
presenting to the ED. HF diagnosis was determined by 2 independent cardiologists who
were blinded to the ED physicians’ diagnoses and to the biomarker levels being examined
in this study.
Results: The mean age of the 1641 subjects was 64±17 years; the 568 (35%) patients
with a final diagnosis of HF were older than those with alternate diagnoses (71 vs. 60
years, p <0.001). In patients without acute HF, median levels of all BACH markers (CTproET,
MR-proADM, MR-proANP, CT-proAVP) increased significantly with increasing age
group (p <0.001), as did levels of MR-proADM (p=0.001) and MR-proANP (p=0.025) in
subjects with HF. The area under the ROC curve was largest in the youngest age group
and decreased with age, suggesting that the BACH markers were stronger predictors in
younger patients
Conclusions: The utility of the studied prohormone biomarkers for diagnosing acute HF
varies by age. The BACH biomarkers proved to be a powerful adjunct to the diagnosis of
HF, especially in younger patient
