Combined assessment of myocardial damage and electrical disturbance in chronic heart failure
Shinpei Kadowaki1, Tetsu Watanabe1, Yoichiro Otaki1
1Shinpei Kadowaki, Tetsu Watanabe, Yoichiro Otaki, Taro Narumi, Yuki Honda, Hiroki Takahashi, Takanori Arimoto, Tetsuro Shishido, Takuya Miyamoto, Isao Kubota, Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan.
Insights
Assessing heart-type fatty acid binding protein (H-FABP) and QRS duration aids in risk-stratifying patients with chronic heart failure (CHF). This combined approach identifies individuals at high risk for cardiac events, improving patient management.
Area of Science:
- Cardiology
- Biomarkers
- Electrophysiology
Background:
- Chronic heart failure (CHF) poses significant risks for cardiac events.
- Accurate risk stratification is crucial for managing CHF patients.
- Novel biomarkers and electrophysiological markers may improve risk assessment.
Purpose of the Study:
- To evaluate the feasibility of combining biochemical (H-FABP) and electrophysiological (QRS duration) markers.
- To assess the utility of this combined approach in risk-stratifying CHF patients.
- To identify predictors of cardiac death and rehospitalization in CHF.
Main Methods:
- Serum heart-type fatty acid binding protein (H-FABP) levels and QRS duration were measured in 322 CHF patients.
- Patients were stratified into four groups based on H-FABP levels and QRS duration (≥ 120 ms).
- Prospective follow-up assessed cardiac deaths and CHF rehospitalizations.
Main Results:
- High H-FABP levels and prolonged QRS duration were independent predictors of cardiac events.
- The combination of high H-FABP and prolonged QRS duration reliably identified high-risk patients.
- Kaplan-Meier analysis showed significant risk stratification (log rank test P < 0.0001).
Conclusions:
- Combined assessment of myocardial damage (H-FABP) and electrical disturbance (QRS duration) is feasible.
- This combined approach effectively risk-stratifies patients with chronic heart failure.
- The findings support integrating these markers for improved CHF patient management.
Aim:
To investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure (CHF).
Methods:
Serum levels of heart-type fatty acid binding protein (H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level (4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF.
Results:
There were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration (≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio (HR) = 1.745, P = 0.021] and QRS prolongation (HR 1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events (log rank test P < 0.0001).
Conclusion:
Combined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF.
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