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Prognostic Value of Combined Biomarkers in Patients With Heart Failure: The Heartmarker Score
Jonna A van der Stam1,2,3, Sjoerd Bouwmeester4, Saskia L M van Loon1,3
1Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
Insights
A new Heartmarker score combining N-terminal pro-B-type natriuretic peptide, ST2, and GDF-15 offers improved risk stratification for heart failure patients compared to traditional methods.
Area of Science:
- Cardiology
- Biomarker Discovery
- Clinical Risk Stratification
Background:
- Heart failure (HF) biomarkers possess prognostic capabilities.
- Accurate risk stratification is crucial for managing HF patients.
- Existing classification systems may require enhancement for precision.
Purpose of the Study:
- To develop an objective classification system for HF risk stratification.
- To combine key HF biomarkers into a novel scoring system.
- To compare the efficacy of the new score against the New York Heart Association (NYHA) classification.
Main Methods:
- Analysis of HF biomarkers including NT-proBNP, ST2, GDF-15, and FGF-23 in 245 HF outpatients.
- Identification of independent predictors of a composite endpoint (HF hospitalization, ICD shock, or death).
- Development of the Heartmarker score using significant biomarkers and comparison with NYHA classification.
Main Results:
- The Heartmarker score was derived from NT-proBNP, ST2, and GDF-15, which were independent predictors of adverse events.
- Higher Heartmarker scores correlated with reduced event-free survival and 6-minute walking test distance.
- The Heartmarker score demonstrated superior discrimination of risk classes compared to the NYHA classification.
Conclusions:
- The Heartmarker score provides a reproducible and intuitive method for risk stratifying HF outpatients.
- Routine biomarker measurements can be effectively utilized for enhanced HF patient management.
- This novel score aids in objective risk assessment, complementing clinical judgment.
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.
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