Prognostic Value of Combined Biomarkers in Patients With Heart Failure: The Heartmarker Score
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Background: Heart failure (HF) biomarkers have prognostic value. The aim of this study was to combine HF biomarkers into an objective classification system for risk stratification of patients with HF. Methods: HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off values (N-terminal pro-B-type natriuretic peptide [NT-proBNP] >1,000 pg/mL, soluble suppression of tumorigenesis-2 [ST2] >35 ng/mL, growth differentiation factor-15 [GDF-15] >2,000 pg/mL, and fibroblast growth factor-23 [FGF-23] >95.4 pg/mL). Biomarkers that remained significant in multivariable analysis were combined to devise the Heartmarker score. The performance of the Heartmarker score was compared to the widely used New York Heart Association (NYHA) classification based on symptoms during ordinary activity. Results: HF biomarkers of 245 patients were analyzed, 45 (18%) of whom experienced the composite endpoint of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. HF biomarkers were elevated more often in patients that reached the composite endpoint than in patients that did not reach the endpoint. NT-proBNP, ST2, and GDF-15 were independent predictors of the composite endpoint and were thus combined as the Heartmarker score. The event-free survival and distance covered in 6 minutes of walking decreased with an increasing Heartmarker score. Compared with the NYHA classification, the Heartmarker score was better at discriminating between different risk classes and had a comparable relationship to functional capacity. Conclusions: The Heartmarker score is a reproducible and intuitive model for risk stratification of outpatients with HF, using routine biomarker measurements.
Abstract
Background: Heart failure (HF) biomarkers have prognostic value. The aim of this study was to combine HF biomarkers into an objective classification system for risk stratification of patients with HF. Methods: HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off values (N-terminal pro-B-type natriuretic peptide [NT-proBNP] >1,000 pg/mL, soluble suppression of tumorigenesis-2 [ST2] >35 ng/mL, growth differentiation factor-15 [GDF-15] >2,000 pg/mL, and fibroblast growth factor-23 [FGF-23] >95.4 pg/mL). Biomarkers that remained significant in multivariable analysis were combined to devise the Heartmarker score. The performance of the Heartmarker score was compared to the widely used New York Heart Association (NYHA) classification based on symptoms during ordinary activity. Results: HF biomarkers of 245 patients were analyzed, 45 (18%) of whom experienced the composite endpoint of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. HF biomarkers were elevated more often in patients that reached the composite endpoint than in patients that did not reach the endpoint. NT-proBNP, ST2, and GDF-15 were independent predictors of the composite endpoint and were thus combined as the Heartmarker score. The event-free survival and distance covered in 6 minutes of walking decreased with an increasing Heartmarker score. Compared with the NYHA classification, the Heartmarker score was better at discriminating between different risk classes and had a comparable relationship to functional capacity. Conclusions: The Heartmarker score is a reproducible and intuitive model for risk stratification of outpatients with HF, using routine biomarker measurements.
참고문헌 (32)
- New York Heart Association, "Nomenclature and criteria for diagnosis of diseases of the heart and great vessels" (1994), Little Brown
- McDonagh TA, "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure", Eur Heart J, 42, pp.3599~3726 (2021)
- Goldman L, "Pitfalls in the serial assessment of cardiac functional status. How a reduction in ‘ordinary’ activity may reduce the apparent degree of cardiac compromise and give a misleading impression of improvement", J Chronic Dis, 35, pp.763~771 (1982)
- Goldman L, "Comparative reproducibility and validity of systems for assessing cardiovascular functional class : advantages of a new specific activity scale", Circulation, 64, pp.1227~1234 (1981)
- Caraballo C, "Clinical implications of the New York Heart Association classification", J Am Heart Assoc, 8, pp.e014240~ (2019)
- Raphael C, "Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure", Heart, 93, pp.476~482 (2007)
- Spinar J, "Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction–A report from FAR NHL prospective registry", PLoS One, 14, pp.e0214363~ (2019)
- Gardner RS, "N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure", Eur Heart J, 24, pp.1735~1743 (2003)
- Kang SH, "Prognostic value of NT-proBNP in heart failure with preserved versus reduced EF", Heart, 101, pp.1881~1888 (2015)
- Poelzl G, "FGF23 is associated with disease severity and prognosis in chronic heart failure", Eur J Clin Invest, 44, pp.1150~1158 (2014)
- Koller L, "Fibroblast growth factor 23 is an independent and specific predictor of mortality in patients with heart failure and reduced ejection fraction", Circ Heart Fail, 8, pp.1059~1067 (2015)
- Roy C, "Fibroblast growth factor 23 : a biomarker of fibrosis and prognosis in heart failure with preserved ejection fraction", ESC Heart Fail, 7, pp.2494~2507 (2020)
- Mendez Fernandez AB, "Growth differentiation factor 15 as mortality predictor in heart failure patients with non-reduced ejection fraction", ESC Heart Fail, 7, pp.2223~2229 (2020)
- Gaggin HK, "Head-to-head comparison of serial soluble ST2, growth differentiation factor-15, and highly-sensitive troponin T measurements in patients with chronic heart failure", JACC Heart Fail, 2, pp.65~72 (2014)
- Kempf T, "Prognostic utility of growth differentiation factor-15 in patients with chronic heart failure", J Am Coll Cardiol, 50, pp.1054~1060 (2007)
- Emdin M, "sST2 predicts outcome in chronic heart failure beyond NT-proBNP and high-sensitivity troponin T", J Am Coll Cardiol, 72, pp.2309~2320 (2018)
- Bouwens E, "Temporal patterns of 14 blood biomarker candidates of cardiac remodeling in relation to prognosis of patients with chronic heart failure-The Bio-SH i FT study", J Am Heart Assoc, 8, pp.e009555~ (2019)
- Masson S, "The fibroblast growth factor-23 and vitamin D emerge as nontraditional risk factors and may affect cardiovascular risk", J Intern Med, 277, pp.318~330 (2015)
- Gaggin HK, "Biomarkers and diagnostics in heart failure", Biochim Biophys Acta, 1832, pp.2442~2450 (2013)
- Sun RR, "Biomarkers and heart disease", Eur Rev Med Pharmacol Sci, 18, pp.2927~2935 (2014)
- Yap J, "Correlation of the New York Heart Association classification and the 6-minute walk distance : A systematic review", Clin Cardiol, 38, pp.621~628 (2015)
- Felker GM, "N-terminal pro-brain natriuretic peptide and exercise capacity in chronic heart failure : data from the Heart Failure and a Controlled Trial Investigating Outcomes of Exercise Training(HF-ACTION)study", Am Heart J, 158, pp.S37~44 (2009)
- Bozkurt B, "Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure", J Card Fail, 27, pp.387~413 (2021)
- Nagueh SF, "Recommendations for the evaluation of left ventricular diastolic function by echocardiography : an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging", J Am Soc Echocardiogr, 29, pp.277~314 (2016)
- Guyatt GH, "The 6-minute walk : a new measure of exercise capacity in patients with chronic heart failure", Can Med Assoc J, 132, pp.919~923 (1985)
- Demers C, "Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure", Am Heart J, 142, pp.698~703 (2001)
- Masson S, "Direct comparison of B-type natriuretic peptide(BNP)and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure : the Valsartan Heart Failure(Val-HeFT)data", Clin Chem, 52, pp.1528~1538 (2006)
- Ky B, "High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure", Circ Heart Fail, 4, pp.180~187 (2011)
- Kuster N, "Multimarker approach including CRP, sST2 and GDF-15 for prognostic stratification in stable heart failure", ESC Heart Fail, 7, pp.2230~2239 (2020)
- Grande D, "A multiparametric approach based on NT-proBNP, ST2, and galectin3 for stratifying one year prognosis of chronic heart failure outpatients", J Cardiovasc Dev Dis, 4, pp.9~ (2017)
- Pocock SJ, "Predicting survival in heart failure : a risk score based on 39 372 patients from 30 studies", Eur Heart J, 34, pp.1404~1413 (2013)
- Levy WC, "The Seattle heart failure model : prediction of survival in heart failure", Circulation, 113, pp.1424~1433 (2006)