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BIOSTAT_outcome_pred_Paper.pdf (1.33 MB)

Cardiovascular and non-cardiovascular death distinction: the utility of troponin beyond N-terminal pro-B-type natriuretic peptide. Findings from the BIOSTAT-CHF study

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journal contribution
posted on 2020-03-30, 12:24 authored by Joao Pedro Ferreira, Wouter Ouwerkerk, Jasper Tromp, Leong Ng, Kenneth Dickstein, Stefan Anker, Gerasimos Filippatos, John G. Cleland, Marco Metra, Dirk J. van Veldhuisen, Adriaan A. Voors, Faiez Zannad
Aims: Heart failure (HF) patients are at high-risk of cardiovascular (CV) events, including CV death. Nonetheless, a substantial proportion of these patients die from non-CV causes. Identifying patients at higher risk for each individual event may help selecting patients for clinical trials and tailoring cardiovascular therapies. The aims of the present study are to: (i) characterize patients according to CV vs. non-CV death; (ii) develop models for the prediction of the respective events; (iii) assess the models' performance to differentiate CV from non-CV death. Methods and results: This study included 2309 patients with HF from the BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) study. Competing-risk models were used to assess the best combination of variables associated with each cause-specific death. Results were validated in an independent cohort of 1738 HF patients. The best model to predict CV death included low blood pressure, estimated glomerular filtration rate ≤ 60 mL/min, peripheral oedema, previous HF hospitalization, ischaemic HF, chronic obstructive pulmonary disease, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin (c-index = 0.73). The non-CV death model incorporated age > 75 years, anaemia and elevated NT-proBNP (c-index = 0.71). Both CV and non-CV death rose by quintiles of the risk scores; yet these models allowed the identification of patients in whom absolute CV death rates clearly outweigh non-CV death ones. These findings were externally replicated, but performed worse in a less severely diseased population. Conclusions: Risk models for predicting CV and non-CV death allowed the identification of patients at higher absolute risk of dying from CV causes (vs. non-CV ones). Troponin helped in predicting CV death only, whereas NT-proBNP helped in the prediction of both CV and non-CV death. These findings can be useful both for tailoring therapies and for patient selection in HF trials in order to attain CV event enrichment.

History

Citation

European Journal of Heart Failure (2020) 22, 81 –89

Author affiliation

Department of Cardiovascular Sciences

Version

  • AM (Accepted Manuscript)

Published in

EUROPEAN JOURNAL OF HEART FAILURE

Volume

22

Pagination

81 –89

Publisher

WILEY

issn

1388-9842

eissn

1879-0844

Acceptance date

2019-09-27

Copyright date

2019

Available date

2019-12-02

Publisher version

https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1654

Spatial coverage

England

Language

English