Τίτλος:
Biomarker-driven prognostic models in chronic heart failure with preserved ejection fraction: the EMPEROR–Preserved trial
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims: Biomarker-driven prognostic models incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) in heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We aimed to generate a biomarker-driven prognostic tool for patients with chronic HFpEF enrolled in EMPEROR-Preserved. Methods and results: Multivariable Cox regression models were created for (i) the primary composite outcome of HF hospitalization or cardiovascular death, (ii) all-cause death, (iii) cardiovascular death, and (iv) HF hospitalization. PARAGON-HF was used as a validation cohort. NT-proBNP and hs-cTnT were the dominant predictors of the primary outcome, and in addition, a shorter time since last hospitalization, New York Heart Association (NYHA) class III or IV, history of chronic obstructive pulmonary disease (COPD), insulin-treated diabetes, low haemoglobin, and a longer time since HF diagnosis were key predictors (eight variables, all p < 0.001). The consequent primary outcome risk score discriminated well (c-statistic = 0.75) with patients in the top 10th of risk having an event rate >22× higher than those in the bottom 10th. A model for HF hospitalization alone had even better discrimination (c = 0.79). Empagliflozin reduced the risk of cardiovascular death or hospitalization for HF in patients across all risk levels. NT-proBNP and hs-cTnT were also the dominant predictors of all-cause and cardiovascular mortality followed by history of COPD, low albumin, older age, left ventricular ejection fraction ≥50%, NYHA class III or IV and insulin-treated diabetes (eight variables, all p < 0.001). The mortality risk model had similar discrimination for all-cause and cardiovascular mortality (c-statistic = 0.72 for both). External validation provided c-statistics of 0.71, 0.71, 0.72, and 0.72 for the primary outcome, HF hospitalization alone, all-cause death, and cardiovascular death, respectively. Conclusions: The combination of NT-proBNP and hs-cTnT along with a few readily available clinical variables provides effective risk discrimination both for morbidity and mortality in patients with HFpEF. A predictive tool-kit facilitates the ready implementation of these risk models in routine clinical practice. © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Συγγραφείς:
Pocock, S.J.
Ferreira, J.P.
Packer, M.
Zannad, F.
Filippatos, G.
Kondo, T.
McMurray, J.J.V.
Solomon, S.D.
Januzzi, J.L.
Iwata, T.
Salsali, A.
Butler, J.
Anker, S.D.
Περιοδικό:
European Journal of Heart Failure
Εκδότης:
John Wiley and Sons Ltd
Λέξεις-κλειδιά:
amino terminal pro brain natriuretic peptide; biological marker; empagliflozin; placebo; troponin T; biological marker; brain natriuretic peptide; insulin derivative; peptide fragment, age distribution; aged; Article; cardiovascular mortality; chronic obstructive lung disease; clinical practice; cohort analysis; controlled study; disease marker; heart failure with preserved ejection fraction; heart left ventricle ejection fraction; hospitalization; human; major clinical study; morbidity; mortality; mortality risk; New York Heart Association class; outcome assessment; prognosis; quality of life; chronic disease; chronic obstructive lung disease; heart failure; heart left ventricle function; heart stroke volume; prognosis, Biomarkers; Chronic Disease; Heart Failure; Humans; Insulins; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Pulmonary Disease, Chronic Obstructive; Stroke Volume; Ventricular Function, Left
