A 3-Biomarker 2-Point-Based Risk Stratification Strategy in Acute Heart Failure

Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge.Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715–0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF).Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747–0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers.Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.

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Prognostic role of sonographic decongestion in patients with acute heart failure with reduced and preserved ejection fraction: a multicentre study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1219 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N.R Pugliese ◽

M Mazzola ◽

G Bandini ◽

G Barbieri ◽

S Spinelli ◽

...

Keyword(s):

Heart Failure ◽

Adverse Events ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Vena Cava ◽

Composite Endpoint ◽

Clinical Findings ◽

Preserved Ejection Fraction ◽

Net Reclassification Improvement ◽

B Lines

Abstract Aims Our aim was to assess the dynamic changes of pulmonary congestion (PC) through variations of sonographic B-lines, in addition to conventional clinical, biohumoral and echocardiographic findings, to improve prognostic stratification of patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF). Methods In this multicenter, prospective, observational study, lung ultrasound was performed in all patients at admission and before discharge by trained investigators, blinded to clinical findings and outcomes. Results We enrolled 208 consecutive patients admitted for acute heart failure (125 HFrEF, 83 HFpEF, mean age 75.9±11.7 years, 36% females, mean ejection fraction 38%). After 180-day follow-up, 38 composite endpoint events occurred (cardiovascular deaths or HF re-hospitalisations). In a multivariate model, B-lines at discharge had independent prognostic value in the overall population together with NT-proBNP, moderate-to-severe mitral regurgitation (MR) and inferior vena cava diameter at admission. When dividing the population in HFrEF and HFpEF, B-lines at discharge was the only independent parameter to predict events in all subgroups. At ROC analysis, a cut-off of B-lines>15 at discharge displayed the highest accuracy in predicting adverse events (AUC=0.80, p<0.0001). The identification of patients unable to halve B-lines during hospitalization (ΔB-lines%), in addition to B-lines >15 at discharge, improved event classification (integrated discrimination improvement=4%, p=0.01; continuous net reclassification improvement=22.8%, p=0.04). Conclusions The presence of residual subclinical sonographic PC at discharge predicts adverse events in the whole spectrum of acute HF patients, independently of conventional biohumoral and echocardiographic parameters. The dynamic evaluation of pulmonary decongestion during hospital stay can further improve patient risk stratification. Funding Acknowledgement Type of funding source: None

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Continuous infusion or bolus injection of loop diuretics for patients admitted for severe acute heart failure: Is one strategy better than the other?

Revista Portuguesa de Cardiologia ◽

10.1016/j.repc.2014.08.019 ◽

2015 ◽

Vol 34 (2) ◽

pp. 95-102 ◽

Cited By ~ 6

Author(s):

Francisca Caetano ◽

Paula Mota ◽

Inês Almeida ◽

Andreia Fernandes ◽

Ana Botelho ◽

...

Keyword(s):

Heart Failure ◽

Continuous Infusion ◽

Acute Heart Failure ◽

Bolus Injection ◽

Loop Diuretics ◽

The Other ◽

Better Than

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Continuous infusion or bolus injection of loop diuretics for patients admitted for severe acute heart failure: Is one strategy better than the other?

Revista Portuguesa de Cardiologia (English Edition) ◽

10.1016/j.repce.2014.08.018 ◽

2015 ◽

Vol 34 (2) ◽

pp. 95-102

Author(s):

Francisca Caetano ◽

Paula Mota ◽

Inês Almeida ◽

Andreia Fernandes ◽

Ana Botelho ◽

...

Keyword(s):

Heart Failure ◽

Continuous Infusion ◽

Acute Heart Failure ◽

Bolus Injection ◽

Loop Diuretics ◽

The Other ◽

Better Than

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Low tri-iodothyronine syndrome improve the risk prediction of mortality in patients with acute heart failure

10.21203/rs.2.16122/v1 ◽

2019 ◽

Author(s):

Jian Zhang ◽

Shengen Liao ◽

Iokfai Cheang ◽

Xinyi Lu ◽

Gongrong Gao ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Risk Prediction ◽

Cardiovascular Mortality ◽

Low T3 Syndrome ◽

Free T3 ◽

Net Reclassification Improvement ◽

Prediction Of Mortality ◽

Low T3 ◽

All Cause Mortality

Abstract Background Clinical studies have suggested that low tri-iodothyronine (T3) syndrome negatively affects the clinical outcomes of patients with acute heart failure (AHF). The aim of this prospective cohort study was to evaluate the effect of low T3 syndrome in terms of prognosis and risk predictive potential in AHF.Methods Low T3 syndrome was defined by a low free T3 level (<3.1 pmol/L) accompanied by a normal thyroid-stimulating hormone level. The association between the free T3 level and mortality and the incremental risk prediction were estimated in adjusted models.Results In total, 312 patients with AHF for whom detailed thyroid hormone profiles were available were prospectively enrolled. Seventy-two patients exhibited low T3 syndrome. Over a median follow-up period of 35 months, 121 cumulative deaths occurred. Cardiovascular death was observed in 94 patients. After extensive adjustment for confounders, the low T3 syndrome associated hazard ratio (95% conﬁdence interval) was 1.74 (1.16-2.61, P =0.007) for all-cause mortality and 1.90 (1.21-2.98, P =0.005) for cardiovascular mortality. The regression splines suggested a negative linear relationship between the free T3 level and mortality risk. Considering reclassification, adding low T3 syndrome to the fully adjusted model improved the risk prediction for all-cause mortality (Integrated discrimination improvement [IDI] 2.0%, P = 0.030; net reclassification improvement [NRI] 8.9%, P = 0.232) and cardiovascular mortality (IDI = 2.5%, P = 0.030; NRI 21.3%, P = 0.013).Conclusions Low T3 syndrome reclassified risk prediction for mortality beyond traditional risk factors.

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Utility of collagen-derived peptides as markers of organ injury in patients with acute heart failure

Open Heart ◽

10.1136/openhrt-2019-001041 ◽

2020 ◽

Vol 7 (1) ◽

pp. e001041

Author(s):

Kazuya Nagao ◽

Akinori Tamura ◽

Yukihito Sato ◽

Reo Hata ◽

Yuichi Kawase ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Excess Risk ◽

Organ Injury ◽

Significant Excess ◽

Net Reclassification Improvement ◽

Significant Excess Risk

ObjectiveThis study aims to investigate the time-dependent prognostic utility of two fibrosis markers representing organ fibrogenesis (N-terminal propeptide of procollagen III (PIIINP) and type IV collagen 7S (P4NP 7S)) in patients with acute heart failure (HF).Methods390 patients with acute HF were dichotomised based on the median value of fibrosis markers at discharge. The primary outcome measure was a composite of cardiac death and HF hospitalisation.ResultsP4NP 7S significantly declined during hospitalisation, whereas PIIINP did not. The cumulative 90-day and 365-day incidence of the primary outcome measure was 16.6% vs 16.0% (p=0.42) and 33.3% vs 28.4% (p=0.34) in the patients with high versus low PIIINP; 19.9% vs 13.0% (p=0.04) and 32.3% vs 29.0% (p=0.34) in the patients with high and low P4NP 7S, respectively. After adjusting for confounders, high P4NP 7S correlated with significant excess risk relative to low P4NP 7S for both 90-day and 365-day primary outcome measure (adjusted HR, 1.50; 95% CI, 1.02 to 2.21; p=0.04 and adjusted HR, 1.89; 95% CI, 1.11 to 3.26; p=0.02, respectively), which was driven by significant association of high P4NP 7S with higher incidence of HF hospitalisation. Furthermore, P4NP 7S exhibited an additive value to conventional prognostic factors for predicting 90-day outcome (p=0.038 for net reclassification improvement; p=0.0068 for integrated discrimination improvement). High PIIINP did not correlate with significant excess risk for both 90-day and 365-day outcome.ConclusionsThis study suggests a possible role of P4NP 7S in the risk stratification of patients with acute HF.

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