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Combination Biomarkers for Risk Stratification in Patients With Chronic Heart Failure Biomarkers Prognostication in
Zekun Feng1, Olumuyiwa P Akinrimisi1, Jeffrey A Gornbein2
1Department of Medicine, UCLA Medical Center, Los Angeles, California.
Insights
New biomarkers, including mid-regional pro-adrenomedullin and a combination panel, show improved prognostication for heart failure with reduced ejection fraction (HFrEF) compared to current standards.
Area of Science:
- Cardiology
- Biomarker Discovery
- Heart Failure Research
Background:
- Current guidelines recommend natriuretic peptide biomarkers for prognosis in chronic heart failure with reduced ejection fraction (HFrEF).
- The efficacy of a combined biomarkers approach for improving prognostication in stable HFrEF requires further investigation.
Purpose of the Study:
- To assess if a combination of biomarkers improves prognostication in patients with stable HFrEF.
- To compare the predictive performance of novel biomarkers against current guideline-recommended biomarkers.
Main Methods:
- An observational cohort study included 202 patients with stable HFrEF undergoing cardiac resynchronization therapy.
- Twenty-four biomarkers were analyzed individually and in combination using Cox regression for major adverse cardiac events (MACE) and MACE plus HF hospitalizations.
- Performance was evaluated using C-statistics.
Main Results:
- Peripheral mid-regional pro-adrenomedullin was the single best biomarker for predicting MACE (C-statistic = 0.771 ± 0.045), outperforming N-terminal pro-b-type natriuretic peptide (C=0.668 ± 0.046).
- The optimal combined biomarkers for MACE prediction included blood urea nitrogen, C-reactive protein, peripheral mid-regional pro-atrial natriuretic peptide, and peripheral soluble IL-1 receptor-like 1 (C=0.767 ± 0.036).
Conclusions:
- Both single (mid-regional pro-adrenomedullin) and combined biomarkers demonstrated superior cardiovascular outcome prediction in HFrEF compared to N-terminal pro-b-type natriuretic peptide.
- Further research and larger studies are necessary to validate these findings and confirm the clinical utility of these biomarkers for HFrEF prognostication.
Background:
Current guidelines recommend measuring natriuretic peptide biomarkers to establish prognosis in patients with chronic heart failure with reduced ejection fraction (HFrEF). We assessed whether a combination biomarkers approach improve prognostication in patients with stable HFrEF.
Methods And Results:
An observational cohort study recruited 202 patients with stable HFrEF at a single center, tertiary care hospital undergoing elective cardiac resynchronization therapy device placement from 2013 to 2015. Twenty-four biomarkers were analyzed individually and in combination using Cox proportion hazard regression model for major adverse cardiac events (ie, death, cardiac transplant, left ventricular assist device placement), and major adverse cardiac events plus HF hospitalizations. The single best biomarker for predicting major adverse cardiac events is peripheral mid-regional pro-adrenomedullin (C statistic = 0.771 ± 0.045) compared to current guideline recommended N-terminal pro b-type natriuretic peptide (C=0.668 ± 0.046). The best combined biomarkers for predicting major adverse cardiac events are blood urea nitrogen, coronary sinus C-reactive protein, peripheral mid-regional pro-atrial natriuretic peptide and peripheral soluble IL-1 receptor-like 1 (C = 0.767 ± 0.036).
Conclusions:
In this observational cohort, the combined biomarkers (blood urea nitrogen, C-reactive protein, mid-regional pro-atrial natriuretic peptide and soluble IL-1 receptor-like 1) or the single biomarker (mid-regional pro-adrenomedullin) was superior to N-terminal pro B-type natriuretic peptide, the current guideline recommended biomarker in predicting cardiovascular outcomes in patients with HFrEF. Larger studies are needed to validate these findings and examine whether single or combined biomarkers improve HFrEF prognostication.
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