Additive value of biomarkers and echocardiography to stratify the risk of death in heart failure patients with reduced ejection fraction

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Abstract

Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions. In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.

Original languageEnglish
Article number1824816
JournalCardiology Research and Practice
Volume2019
DOIs
Publication statusPublished - Jan 1 2019

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Echocardiography
Heart Failure
Biomarkers
Natriuretic Peptides
Troponin I
Outpatients
Proportional Hazards Models
Stroke Volume
Pulmonary Artery
Multicenter Studies
Observational Studies
Cause of Death
Demography
4-S-(propionic acid)sulfidocyclophosphamide
Pressure
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{7fe7b44b6ba24c419065801ce2304f66,
title = "Additive value of biomarkers and echocardiography to stratify the risk of death in heart failure patients with reduced ejection fraction",
abstract = "Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions. In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.",
author = "Calogero Falletta and Francesco Clemenza and Catherine Klersy and Valentina Agnese and Diego Bellavia and {Di Gesaro}, Gabriele and Chiara Min{\`a} and Giuseppe Romano and Temporelli, {Pier Luigi} and Dini, {Frank Lloyd} and Andrea Rossi and Claudia Raineri and Annalisa Turco and Egidio Traversi and Stefano Ghio and Andrea Salzano",
year = "2019",
month = "1",
day = "1",
doi = "10.1155/2019/1824816",
language = "English",
volume = "2019",
journal = "Cardiology Research and Practice",
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TY - JOUR

T1 - Additive value of biomarkers and echocardiography to stratify the risk of death in heart failure patients with reduced ejection fraction

AU - Falletta, Calogero

AU - Clemenza, Francesco

AU - Klersy, Catherine

AU - Agnese, Valentina

AU - Bellavia, Diego

AU - Di Gesaro, Gabriele

AU - Minà, Chiara

AU - Romano, Giuseppe

AU - Temporelli, Pier Luigi

AU - Dini, Frank Lloyd

AU - Rossi, Andrea

AU - Raineri, Claudia

AU - Turco, Annalisa

AU - Traversi, Egidio

AU - Ghio, Stefano

AU - Salzano, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions. In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.

AB - Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions. In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.

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SN - 2090-0597

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