Does renal impairment increase mortality risk in patients with heart failure?

Introduction: Mortality among patients with heart failure (HF) is high. Though individual biomarkers have been studied to determine their value in risk prediction, the role of a multimarker strategy in predicting mortality above established risk indicators requires evaluation in a relevant cohort using robust analytical methods. Objective: To determine whether adding C-reactive protein (CRP), B-type natriuretic peptide (BNP), and troponin T (TnT) to established risk indicators improved HF mortality risk prediction. Methods: Olmsted County residents presenting with HF from July 2004 to September 2007 were prospectively recruited to undergo biomarker measurement. We investigated whether addition of CRP, BNP, and TnT to a model including established risk indicators improved 6-month mortality risk prediction using multiple methods ( c statistic, net reclassification index, integrated discrimination improvement). Results: Of 566 participants (mean age 77±13 years, 48% male), 87(15%) patients died after 6 months follow-up. Patients with CRP (<12.1mg/L), BNP (<341pg/mL), and TnT (≥0.01ng/mL) below the median (n=112) had the lowest mortality (3%), those with one or two biomarkers above the median had intermediate mortality, and those with all biomarkers above the median (n=105) had markedly increased 6-month mortality (33%). After adjustment for other predictors, higher CRP, BNP, and TnT were each associated with increased mortality, with odds ratios (95% confidence intervals) of 1.66(1.24 –2.24), 2.06(1.42–3.07), and 1.45(1.12–1.87), respectively. While adding CRP, BNP, and TnT individually to the model improved mortality risk prediction, the combination of two or more biomarkers offered greater incremental benefit. Using all biomarkers resulted in an increase in the c statistic from 0.747 to 0.832 (p<0.001), a net reclassification index of 0.33 (p<0.001), and a 100% relative improvement in risk discrimination (integrated discrimination improvement 0.097, p<0.001). Conclusions: The combined use of CRP, BNP, and TnT markedly improved the prediction of 6-month mortality in HF beyond established risk indicators. Implementation of a multimarker strategy including CRP, BNP, and TnT for risk prediction in HF should be considered. This research has received full or partial funding support from the American Heart Association, AHA Midwest Affiliate (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota & Wisconsin).

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Abstract MP33: Heart Failure Following Cancer Therapy in Patients with Hematological Malignancies Aged 18 Years and Under: A Linked Health Data Analysis (1996-2009)

Circulation ◽

10.1161/circ.133.suppl_1.mp33 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Narelle M Berry ◽

Shahid Ullah ◽

Vincent L Versace ◽

Alexandra L McCarthy ◽

John J Atherton ◽

...

Keyword(s):

Heart Failure ◽

Cancer Diagnosis ◽

Mortality Risk ◽

Hematological Malignancies ◽

Causal Link ◽

Health Data ◽

Innovative Strategies ◽

Hematological Cancers ◽

Patients With Heart Failure ◽

After Cancer

Introduction: The causal link between chemotherapy treatments and subsequent cardiotoxicity is well established, particularly for children with hematological malignancies. Little information exists on the characteristics and outcomes for patients with heart failure (HF) after chemotherapy. This study aimed to describe the characteristics, survival and mortality of patients who received chemotherapy for hematological cancer (leukemias, lymphomas and related disorders) before 18 years old and subsequently developed HF compared to those who did not. Methods: Linked health data (1996-2009) from the Queensland Cancer Registry, Death Registry and Hospital Administration records for HF and chemotherapy admissions were reviewed. From all breast and hematological cancers patients (n=73,158), 15,987 received chemotherapy, including 819 patients aged ≤18 years at time of cancer diagnosis. Patients were categorized as those with an index HF admission (occurred after cancer diagnosis) and those without an index HF admission (non HF). Results: Of the 819 patients, 3.7% (n=30) had an index HF admission. Median age of HF patients at time of cancer diagnosis was 5 years (IQR 3-12) compared to 7 years (IQR 3-14) in the non HF group (p=0.503). Median follow up from cancer diagnosis was 2.5 years in the HF group compared to 5.42 years in the non HF group (p<0.01). Of those who developed HF, 70% (n=21) had the index admission within 12 months of their cancer diagnosis. Of those with HF, 53.3% (n=16) died (all cause) compared to 14.6% (n=115) with no HF. On adjustment for age, sex and chemotherapy admissions, HF patients had an almost 5 fold increased mortality risk compared to non HF patients (HR 4.91 [95% CI, 2.88-8.36]) (Figure 1). Conclusions: This study demonstrated that in children with hematological cancers the onset of HF occurred soon after chemotherapy and mortality risk is almost 5 times that of children who do not develop HF. Innovative strategies are still needed for the prevention and management of cardiotoxicity in this population.

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Abstract 13677: Usefulness of 2-year Iodine-123 Metaiodobenzylguanidine-based Risk Model for the Post-discharge Risk Stratification in Acute Decompensated Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.13677 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Shunsuke Tamaki ◽

Takahisa Yamada ◽

Tetsuya Watanabe ◽

Takashi Morita ◽

Yoshio Furukawa ◽

...

Keyword(s):

Heart Failure ◽

Risk Score ◽

Mortality Risk ◽

Risk Model ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Cardiac Mortality ◽

Post Discharge ◽

Patients With Heart Failure ◽

Iodine 123

Background: A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in patients with heart failure with preserved LVEF (HFpEF) who are admitted with acute decompensated heart failure (ADHF). Methods and Results: Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka. We studied 239 patients who survived to discharge. Cardiac MIBG imaging was performed just before discharge. The 2-year cardiac mortality risk score was calculated using four parameters, including age, LVEF, NYHA functional class, and the cardiac MIBG heart-to-mediastinum ratio on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4-12%), and high-risk (>12%) groups. The endpoint was all-cause death. During a follow-up period of 1.6±0.8 years, 33 patients had all-cause death. Multivariate Cox analysis showed that 2-year MIBG-based cardiac mortality risk score was an independent predictor of all-cause death (p=0.0009). There was significant difference in the rate of all-cause death among the three groups stratified by 2-year cardiac mortality risk score (Figure). Conclusions: In this multicenter study, the 2-year MIBG-based cardiac mortality risk score was shown to be useful for the prediction of post-discharge clinical outcome in HFpEF patients admitted for ADHF.

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External Validation and Refinement of Emergency Heart Failure Mortality Risk Grade Risk Model in Patients With Heart Failure in the Emergency Department

CJC Open ◽

10.1016/j.cjco.2019.03.003 ◽

2019 ◽

Vol 1 (3) ◽

pp. 123-130

Author(s):

Nariman Sepehrvand ◽

Erik Youngson ◽

Jeffrey A. Bakal ◽

Finlay A. McAlister ◽

Brian H. Rowe ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Mortality Risk ◽

Risk Model ◽

External Validation ◽

Patients With Heart Failure ◽

Risk Grade

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Mechanisms underlying increased mortality risk in patients with heart failure and reduced ejection fraction randomly assigned to adaptive servoventilation in the SERVE-HF study: results of a secondary multistate modelling analysis

The Lancet Respiratory Medicine ◽

10.1016/s2213-2600(16)30244-2 ◽

2016 ◽

Vol 4 (11) ◽

pp. 873-881 ◽

Cited By ~ 56

Author(s):

Christine Eulenburg ◽

Karl Wegscheider ◽

Holger Woehrle ◽

Christiane Angermann ◽

Marie-Pia d'Ortho ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Mortality Risk ◽

Adaptive Servoventilation ◽

Reduced Ejection Fraction ◽

Modelling Analysis ◽

Study Results ◽

Patients With Heart Failure

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Effects of atrial natriuretic peptide on acute renal impairment in patients with heart failure after cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/1053-0770(94)90377-8 ◽

1994 ◽

Vol 8 (5) ◽

pp. 68

Author(s):

Felix Valsson ◽

Sven-Erik Ricksten ◽

Thomas Hedner ◽

Stefan Lundin

Keyword(s):

Heart Failure ◽

Cardiac Surgery ◽

Renal Impairment ◽

Atrial Natriuretic Peptide ◽

Natriuretic Peptide ◽

Patients With Heart Failure ◽

Atrial Natriuretic

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Effect of Angiotensin–Neprilysin Versus Renin–Angiotensin System Inhibition on Renal Outcomes: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.604017 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ying Xu ◽

Yang Chen ◽

Jia Wei Zhao ◽

Chao Li ◽

Amanda Y Wang

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Renal Impairment ◽

Lower Incidence ◽

Meta Analysis ◽

Drug Discontinuation ◽

Controlled Trials ◽

Randomized Controlled ◽

Patients With Heart Failure ◽

Severe Hyperkalemia

Aims: We aim to perform a systematic review and meta-analysis examining randomized controlled trials assessing the efficacy and safety of sacubitril/valsartan in patients on renal outcomes, in comparison with the renin–angiotensin–aldosterone system inhibitor (RAASi).Methods: Eligible studies were retrieved on MEDLINE, EMBASE, and Cochrane until September 2021. The primary outcome was the incidence of renal impairment, which was defined as the composite of increases in serum creatinine by >0.3 mg/dl and/or a reduction in eGFR ≥25%, development of ESRD, or renal death. We pooled relative risks (RRs) with 95% confidence intervals (CIs) or the mean difference with 95% CIs for the variables.Results: Our search yielded 10 randomized controlled trials with a total of 18,362 patients. Compared with RAASi treatment, patients treated with sacubitril/valsartan had lower incidence of composite renal impairment (10 studies, 18,362 patients, RR 0.84; 95% CI 0.72–0.96, p = 0.01; I2 = 22%), ESRD development (3 studies, 13,609 patients, RR 0.53; 95% CI 0.30–0.96, p = 0.03; I2 = 0%), drug discontinuation due to renal events (4 studies, 9,995 patients, RR 0.58; 95% CI 0.40–0.83, p = 0.003; I2 = 47%), severe hyperkalemia (6 studies, 16,653 patients, RR 0.80; 95% CI 0.68–0.93, p = 0.01; I2 = 25%) and a slower eGFR decline (4 studies, 13,608 patients, WMD 0.56; 95% CI 0.36–0.76, p < 0.00001; I2 = 65%). Subgroup analysis demonstrated that sacubitril/valsartan was associated with a lower incidence of renal impairment in patients with heart failure and preserved ejection fraction (HFpEF), but not in those with heart failure and reduced ejection fraction (HFrEF). The superior renal function preservation of sacubitril/valsartan treatment was not associated with different baseline eGFR levels and follow-up duration. There was a smaller increase in the change in the urine albumin-to-creatinine ratio (UACR) (3 studies, 9,114 patients, SMD 0.06; 95% CI 0.02–0.10, p = 0.003; I2 = 14%) with sacubitril/valsartan treatment. However, patients with heart failure appeared to have increased microalbuminuria, not patients without HF (p = 0.80 for interaction).Conclusion: Sacubitril/valsartan was associated with a lower incidence of composite renal impairment especially in patients with HFpEF, but higher microalbuminuria in patients with heart failure (both HFrEF and HFpEF) compared with RAASi. The lower incidence of severe hyperkalemia and drug discontinuation due to renal events in patients with sacubitril/valsartan treatment demonstrated its superior safety compared with RAASi.

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