المؤلفون: Aimo, Alberto, Januzzi, James L., Jr, Vergaro, Giuseppe, Ripoli, Andrea, Latini, Roberto, Masson, Serge, Magnoli, Michela, Anand, Inder S., Cohn, Jay N, Tavazzi, Luigi, Tognoni, Gianni, Gravning, Jørgen, Ueland, Thor, Nymo, Ståle H, Rocca, Hans-Peter Brunner-La, Bayes-Genis, Antoni, Lupón, Josep, de Boer, Rudolf A., Yoshihisa, Akiomi, Takeishi, Yasuchika, Egstrup, Michael, Gustafsson, Ida, Gaggin, Hanna K., Eggers, Kai M., 1962, Huber, Kurt, Tentzeris, Ioannis, Wilson Tang, W. H., Grodin, Justin L, Passino, Claudio, Emdin, Michele

المصدر: International Journal of Cardiology. 277:166-172

مصطلحات موضوعية: Heart failure, Prognosis, Renal function, Troponin

الوصف: Background: In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis.Methods and results: 9289 patients (66 ± 12 years, 77% men, 85% LVEF <40%, 60% ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m2 (interquartile interval 46–70; n = 9220), hs-TnT 16 ng/L (8–20; n = 9289), NT-proBNP 1067 ng/L (433–2470; n = 8845), and hs-CRP 3.3 mg/L (1.4–7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54% per doubling of hs-TnT vs. 24% per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes.Conclusions: hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.

وصف الملف: print

الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-374939Test

المؤلفون: Aimo, Alberto¹ (AUTHOR) albertoaimo@libero.it, Januzzi, James L.¹ (AUTHOR), Mueller, Christian¹ (AUTHOR), Mirò, Oscar¹ (AUTHOR), Pascual Figal, Domingo A.¹ (AUTHOR), Jacob, Javier¹ (AUTHOR), Herrero-Puente, Pablo¹ (AUTHOR), Llorens, Pere¹ (AUTHOR), Wussler, Desiree¹ (AUTHOR), Kozhuharov, Nikola¹ (AUTHOR), Sabti, Zaid¹ (AUTHOR), Breidthardt, Tobias¹ (AUTHOR), Vergaro, Giuseppe¹ (AUTHOR), Ripoli, Andrea¹ (AUTHOR), Prontera, Concetta¹ (AUTHOR), Saccaro, Luigi¹ (AUTHOR), Passino, Claudio¹ (AUTHOR), Emdin, Michele¹ (AUTHOR)

المصدر: International Journal of Cardiology. Oct2019, Vol. 293, p137-142. 6p.

مصطلحات موضوعية: *HEART failure, *NATRIURETIC peptides, *HOSPITAL mortality, *ABSOLUTE value, *HOSPITAL admission & discharge

مستخلص: High-sensitivity troponin T (hs-TnT) reflects the severity of ongoing myocardial damage. In acute heart failure (AHF), its additive prognostic value over B-type natriuretic peptides is unclear. Individual data of 1499 AHF patients with admission hs-TnT were collected from 3 cohorts. Patients (78 ± 10 years, 51% men, N-terminal fragment of pro-B-type natriuretic peptide – NT-proBNP - 5660 [2693–12,466], hs-TnT 43 ng/L [26–69]) experiencing in-hospital death (n = 187, 13%) had significantly higher hs-TnT and NT-proBNP on admission (both p < 0.001). Patients with hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L had a 2.7-fold higher risk of in-hospital death (relative risk - RR 2.7, 95% confidence interval - CI 1.7–4.5). Among discharged patients, 1024 deaths (81%) occurred over 11 months (4–22). In the whole population, hs-TnT ≥43 ng/L predicted all-cause death at 6, 12 and 24 months independently from NT-proBNP ≥5660 ng/L. The best NT-proBNP cut-off for in-hospital mortality (4382 ng/L) independently predicted this endpoint, while the best hs-TnT cut-off (55 ng/L) did not. Patients with NT-proBNP ≥4382 ng/L and hs-TnT ≥55 ng/L had a 12-fold higher risk of in-hospital death (RR 11.7, 95% CI 6.9–19.7). The best hs-TnT cut-offs independently predicted all post-discharge outcomes. The best NT-proBNP cut-off (4382 ng/L) independently predicts outcome, while the best hs-TnT (55 ng/L) does not; patients with both biomarkers ≥best cut-offs have a 12-fold higher risk of in-hospital mortality. Admission hs-TnT ≥43 ng/L and the best hs-TnT cut-offs hold independent prognostic significance for post-discharge outcome, while hs-TnT seems less predictive than NT-proBNP when considering absolute values. • Admission hs-TnT 43 ng/L cut-off refines risk stratification of post-discharge outcome over NT-proBNP 5660 ng/L. • Patients with NT-proBNP ≥4382 ng/L and hs-TnT ≥55 ng/L have an almost 12-fold higher risk of in-hospital death. • hs-TnT ≥43 ng/L independently predicts post-discharge outcome over NT-proBNP ≥5660 ng/L. • The best hs-TnT cut-offs are more predictive of post-discharge outcome than the best NT-proBNP cut-offs. • Absolute NT-proBNP levels are more predictive than hs-TnT for post-discharge outcome. [ABSTRACT FROM AUTHOR]

المؤلفون: Aimo, Alberto¹ a.aimo@santannapisa.it, Januzzi, James L.¹, Vergaro, Giuseppe¹, Petersen, Christina¹, Pasanisi, Emilio M.¹, Molinaro, Sabrina¹, Passino, Claudio¹, Emdin, Michele¹

المصدر: International Journal of Cardiology. Dec2018, Vol. 273, p136-140. 5p.

مصطلحات موضوعية: *HEART failure, *VENTRICULAR ejection fraction, *ETIOLOGY of diseases, *CARDIOVASCULAR agents, *NATRIURETIC peptides

مستخلص: Abstract Background Left ventricular ejection fraction (LVEF) represents the most used measure of cardiac systolic function. Different cut-offs have been proposed to classify patients with systolic dysfunction, and to inform therapy decision-making. Methods Consecutive outpatients with systolic heart failure (HF; LVEF <50%) were prospectively enrolled and underwent a baseline characterization. The prognostic value of LVEF and LVEF cut-offs was made with regards to the prediction of all-cause and cardiovascular death. Results Out of 2160 patients, 71% had LVEF <40%, and 61% had ≤35%. Over a 26-month median follow-up (interquartile interval 12–39), patients with LVEF ≤35% (log-rank 31.11 and 59.48, respectively; both p < 0.001) and <40% (log-rank 24.51 and 41.77, respectively; both p < 0.001) had a significantly worse prognosis for all-cause and cardiovascular death. LVEF independently predicted both endpoints in a strong prognostic model including age, sex, ischaemic aetiology, N-terminal fraction of pro-B-type natriuretic peptide, New York Heart Association class III–IV, several comorbidities and therapies. Receiver operating characteristics curves identified LVEF values 32% and 31% as the best cut-offs for the two endpoints. The 40% and lower cut-offs (35%, 32% or 31%) were independent predictors of all-cause and cardiovascular death (p < 0.001 in all cases). The 35% cut-off had a lower Akaike's Information Criterion value than 40%, denoting more accurate risk stratification. Conclusions LVEF is an independent predictor of all-cause and cardiovascular mortality in chronic systolic HF. The 35% LVEF cut-off displays a better combination of sensitivity and specificity than the 40% cut-off for outcome prediction, although both hold independent prognostic value. Highlights • Left ventricular ejection fraction (LVEF) is the most used measure of cardiac systolic function. • LVEF is independent predictor of all-cause and cardiovascular mortality. • The 35% LVEF cut-off performs better than 40% for outcome prediction. [ABSTRACT FROM AUTHOR]

المؤلفون: Vergaro, Giuseppe¹ vergaro@ftgm.it, Januzzi, James L.¹, Cohen Solal, Alain¹, Aimo, Alberto¹, Arzilli, Chiara¹, Zyw, Luc¹, Valleggi, Alessandro¹, Giannoni, Alberto¹, Prontera, Concetta¹, Barison, Andrea¹, Poletti, Roberta¹, Gabutti, Alessandra¹, Mammini, Chiara¹, Passino, Claudio¹, Emdin, Michele¹

المصدر: International Journal of Cardiology. Nov2018, Vol. 271, p324-330. 7p.

مصطلحات موضوعية: *HEART failure, *NATRIURETIC peptides, *HEART transplantation, *CARDIOVASCULAR disease diagnosis, *MORTALITY

مستخلص: Abstract Background Circulating concentrations of N-terminal fragment of the prohormone of brain natriuretic peptide (NT-proBNP) are influenced by age and common age-related comorbidities, such as renal dysfunction. Therefore, utility of NT-proBNP for prediction of prognosis in the aged has been questioned. We aimed to investigate the prognostic value of NT-proBNP across age classes in a cohort of patients with chronic systolic HF. Methods and results We enrolled 2364 consecutive outpatients with HF and left ventricular ejection fraction ≤50%. Patients were classified according to age quartiles, and a very elderly subgroup was identified, aged ≥85 years. After baseline assessment (including NT-proBNP testing), patients were followed-up for the composite of cardiovascular death, heart transplantation or ventricular assistance device implantation (primary outcome) and for all-cause death (secondary outcome). Patients in the fourth quartile (Q4, age ≥ 77 years, n = 638) and in the very elderly subgroup (age ≥ 85 years, n = 153), had higher NT-proBNP (p <.001 vs Q1). NT-proBNP was independently associated with primary and secondary outcome at 1- and 5-years follow-up in the whole population, as well as in Q4 and in the very elderly subgroup (all p <.05). Compared to the whole population, Q4 and very elderly had higher NT-proBNP cut-off for prediction of 1-year primary (4188 and 9729 ng/l, respectively vs 3710 ng/l) and secondary outcome (4296 and 7634 ng/l, respectively vs 3056 ng/l). Conclusions NT-proBNP predicts mortality in elderly and very elderly patients with chronic systolic HF, both at mid- and long-term follow-up. Higher NT-proBNP prognostic cut-off should be considered in the aged HF population. Highlights • NT-proBNP predicts outcome in elderly and very elderly patients with heart failure. • Risk associated with high NT-proBNP increases with age, peaking in the oldest old. • Higher NT-proBNP cut-offs are to be considered in elderly patients. • Circulating NT-proBNP has different clinical correlates depending on patients' age. [ABSTRACT FROM AUTHOR]

المؤلفون: Mohebi, Reza^1,2 (AUTHOR), Liu, Yuxi^1,2 (AUTHOR), Murphy, Sean P.^1,2 (AUTHOR), Gaggin, Hanna K.^1,2,3 (AUTHOR), Januzzi, James L.^1,2,3 (AUTHOR) jjanuzzi@partners.org

المصدر: International Journal of Cardiology. May2023, Vol. 378, p71-76. 6p.

مصطلحات موضوعية: *HEART failure, *VENTRICULAR ejection fraction, *DATABASES, *MACHINE learning, *PROPORTIONAL hazards models, *PROGNOSIS

مستخلص: End-stage (Stage D) heart failure with preserved ejection fraction (HFpEF) is a poorly characterized syndrome that has heterogeneous underlying pathophysiology. A better characterization of the various clinical profiles of Stage D HFpEF is needed. 1066 patients with Stage D HFpEF were selected from National Readmission Database. A Bayesian clustering algorithm based on a Dirichlet process mixture model was implemented. Cox proportional hazard regression model was used to relate the risk of in-hospital mortality with each identified clinical cluster. 4 distinct clinical clusters were recognized. Group 1 had a higher prevalence of obesity (84.5%) and sleep disorders (62.0%). Group 2 had a higher prevalence of diabetes mellitus (92%), chronic kidney disease (98.3%), anemia (72.6%), and coronary artery disease (59.0%). Group 3 had a higher prevalence of advanced age (82.1%), hypothyroidism (28.9%), dementia (17.0%), atrial fibrillation (63.8%) and valvular disease (30.5%) and Group 4 had a higher prevalence of liver disease (44.5%), right-sided HF (20.2%) and amyloidosis (4.5%). During 2019, 193 (18.1%) in-hospital mortality events occurred. Considering Group 1 (with mortality rate of 4.1%) as a reference, the hazard ratio of in-hospital mortality was 5.4 [95% confidence interval (CI): 2.2–13.6] for Group 2, 6.4 (95% CI: 2.6–15.8) for Group 3 and 9.1 (95% CI: 3.5–23.8) for Group 4. End-stage HFpEF presents with different clinical profiles with varied upstream causes. This may help provide evidence toward the development of targeted therapies. • Heart failure with preserved ejection is a heterogenous clinical syndrome with varying prognosis. • Using unsupervised machine learning algorithm, 4 clinical profiles were identified. 1) obese patients with sleep and lung disorders. 2) patients with cardiometabolic comorbidities 3) Elderly with valvular and arrhythmias 4) patients with biventricular failure and liver involvement. • Clinical profiles of End stage HFpEF according to cardiac and non-cardiac comorbidities can help healthcare professional estimate disease prognosis. [ABSTRACT FROM AUTHOR]

المؤلفون: Mohebi, Reza^1,2 (AUTHOR), van Kimmenade, Roland³ (AUTHOR), McCarthy, Cian P.^1,2 (AUTHOR), Magaret, Craig A.⁴ (AUTHOR), Barnes, Grady⁴ (AUTHOR), Rhyne, Rhonda F.⁴ (AUTHOR), Gaggin, Hanna K.^1,2 (AUTHOR), Januzzi, James L.^1,2,5 (AUTHOR) jjanuzzi@partners.org

المصدر: International Journal of Cardiology. Jan2023, Vol. 371, p402-405. 4p.

مصطلحات موضوعية: *CHRONIC kidney failure, *CHRONICALLY ill, *MACHINE learning, *NATRIURETIC peptides, *KIDNEY diseases, *PEPTIDES, *RETENTION of urine, *KIDNEY transplantation, *URINARY catheterization

مستخلص: Patients with chronic kidney disease (CKD) undergoing coronary catheterization are at increased risk of cardiovascular events (CVE). Measuring biomarkers before the procedure may guide clinicians in identifying patients at higher risk of future cardiovascular events. In this sub-study the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA), 927 patients underwent coronary catheterization and were followed up for two years. Using machine learning algorithm and targeted proteomics from samples of patients with CKD, 4 biomarkers (kidney injury molecule-1, N-terminal pro B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) were integrated into a prognostic algorithm to predict CVE. Results from the panel are expressed in a graded fashion (CVE higher risk and lower risk) using a data-driven cutoff optimized for balanced sensitivity and specificity. During the 2-year follow-up, 74 CVE were ascertained. 51 (rate: 51/378 = 13.5%) events occurred in stage 1–2 CKD and 23 (rate: 23/68 = 33.8%) events occurred in stage 3–5 CKD. The C-statistic for predicting 2-years cardiovascular events in all 446 patients was 0.77 (0.72, 0.82). The model was well-calibrated (Hosmer-Lemeshow test p -value >0.40). Considering patients at CVE lower-risk within each CKD staging group as a reference, the hazard ratio (95% confidence interval) of cardiovascular events was 2.82 (1.53, 5.22) for CKD stage 1–2/CVE higher-risk, and 8.32 (1.12, 61.76) for CKD stage 3–5/CVE higher-risk. Measuring biomarker panel prior to coronary catheterization may be useful to individualize CVE risk assessment among patients with CKD. HART-CVE panel can help clinicians recognize individuals at high risk of cardiovascular events prior to angiographic procedures among patients at different stages of chronic kidney disease. *Incidence rates are presented as cases per 100 person years. Abbreviations: IR: incidence rate, CKD: chronic kidney disease, CVE: cardiovascular event, HR: hazard ratio, CI: confidence interval, KIM-1: kidney injury molecule-1, NTproBNP: N terminal pro B-type natriuretic peptides, TIMP-1: Tissue inhibitor matrix metalloproteinase-1. [Display omitted] • Patients with chronic kidney disease are at increased risk of cardiovascular events following coronary catheterization. Preceding coronary catheterization is an ideal time to measure biomarkers and estimate risk for future cardiovascular events. • Using a machine learning algorithm and targeted proteomics, we demonstrated that measuring four biomarkers (kidney injury molecule-1, N-terminal pro B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) can individualize cardiovascular events risk assessment among patients with chronic kidney disease • Future clinical trials may assess the efficacy of implementing the HART CVE model in lowering cardiovascular events compared to the standard of care [ABSTRACT FROM AUTHOR]

المؤلفون: Lupón, Josep^1,2, Sanders-van Wijk, Sandra³, Januzzi, James L.⁴, de Antonio, Marta¹, Gaggin, Hanna K.⁴, Pfisterer, Matthias⁵, Galán, Amparo⁶, Shah, Ravi⁴, Brunner-La Rocca, Hans-Peter³, Bayes-Genis, Antoni^1,2 abayesgenis@gmail.com

المصدر: International Journal of Cardiology. Feb2016, Vol. 204, p242-247. 6p.

مصطلحات موضوعية: *HEART failure treatment, *VENTRICULAR remodeling, *VENTRICULAR ejection fraction, *ETIOLOGY of diseases, *DIASTOLE (Cardiac cycle), *HEALTH outcome assessment

مستخلص: Background Cardiac remodeling and its reversibility are key in HF outcomes. The ST2-R2 score was recently developed to predict relevant left ventricular (LV) reverse remodeling (R2) in patients with heart failure (HF). In the present study we sought to validate the ST2-R2 score for grading improvement in LV ejection fraction (EF) and LV size at one year, and to evaluate its prognostic implication up to 4 years. Methods A total of 569 patients with baseline LVEF < 40% from three international cohorts (Barcelona, TIME-CHF, and PROTECT) were included in the study. Patients were classified into four strata based on their ST2-R2 score, which took into account concentrations of the biomarker ST2, non-ischemic etiology, absence of left bundle branch block, HF duration, baseline LVEF, and β-blocker treatment. Results A significant relationship was observed between ST2-R2 scores and changes in LVEF and indexed LV sizes. LVEF recovery (from + 5.6% to + 17.3%; p < 0.001), percentage reduction in LV end-systolic volume index (from − 6.1% to − 32.1%; p < 0.001) and in LV end-systolic diameter index (from − 1.1% to − 18.6%; p < 0.001) increased over the ST2-R2 strata. A similar trend was observed with diastolic parameters. Improvement in LV function and size was inversely predictive of mortality. Hazard ratios for risk of death, using the lower ST2-R2 score strata (< 9) as a reference, were 0.49 (p < 0.001; score 9–11), 0.27 (p < 0.001; score 12–14), and 0.17 (p < 0.001; score 15–17). Conclusions The ST2-R2 score predicts reverse LV remodeling in HF patients and is useful for predicting mortality up to 4 years. [ABSTRACT FROM AUTHOR]

المؤلفون: Chatterjee, Neal A.¹, Singh, Jagmeet P.^1,2, Szymonifka, Jackie³, Deaño, Roderick C.³, Thai, Wai-ee⁴, Wai, Bryan⁴, Min, James K.³, Januzzi, James L.¹, Truong, Quynh A.³ qat9001@med.cornell.edu

المصدر: International Journal of Cardiology. Feb2016, Vol. 205, p43-49. 7p.

مصطلحات موضوعية: *CYSTATINS, *CARDIAC pacing, *HEART failure, *MORTALITY, *CREATININE, *HEALTH outcome assessment

مستخلص: Background Despite the benefit of CRT in select patients with heart failure (HF), there remains significant need for predicting those at risk for adverse outcomes for this effective but costly therapy. CysC, an emerging marker of renal function, is predictive of worsening symptoms and mortality in patients with HF. This study assessed the utility of baseline and serial measures of cystatin C (CysC), compared to conventional creatinine-based measures of renal function (estimated glomerular filtration rate, eGFR), in predicting clinical outcomes following cardiac resynchronization therapy (CRT). Methods In 133 patients, we measured peripheral venous (PV) and coronary sinus (CS) CysC concentrations and peripheral creatinine levels at the time of CRT implant. Study endpoints included clinical response to CRT at 6 months and major adverse cardiac events (MACE) at 2 years. Results While all 3 renal metrics were predictive of MACE (all adjusted p ≤ 0.02), only CysC was associated with CRT non-response at 6 months (adjusted odds ratio 3.6, p = 0.02). CysC improved prediction of CRT non-response (p ≤ 0.003) in net reclassification index analysis compared to models utilizing standard renal metrics. Serial CysC > 1 mg/L was associated with 6-month CRT non-response and reduced 6-minute walk distance as well as 2-year MACE (all p ≤ 0.04). Conclusion In patients undergoing CRT, CysC demonstrated incremental benefit in the prediction of CRT non-response when compared to standard metrics of renal function. Baseline and serial measures of elevated CysC were predictive of CRT non-response and functional status at 6 months as well as long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

المؤلفون: Lupón, Josep^1,2, Gaggin, Hanna K.³, de Antonio, Marta^1,2, Domingo, Mar¹, Galán, Amparo⁴, Zamora, Elisabet^1,2, Vila, Joan^5,6, Peñafiel, Judith^5,6, Urrutia, Agustín^1,2, Ferrer, Elena¹, Vallejo, Nuria¹, Januzzi, James L.³, Bayes-Genis, Antoni^1,2 abayesgenis@gmail.com

المصدر: International Journal of Cardiology. Apr2015, Vol. 184, p337-343. 7p.

مصطلحات موضوعية: *HEART failure, *NATRIURETIC peptides, *GALECTINS, *LOGISTIC regression analysis, *HEART failure treatment, *VENTRICULAR remodeling, *PROGNOSIS

مستخلص: Background Limited data exists regarding biomarker use to predict left ventricular (LV) reverse remodeling (R2). Our aim was to examine the value of soluble ST2 (ST2), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and galectin-3 relative to LV-R2 in systolic heart failure (HF), and to develop a clinical score for LV-R2 prediction. Methods R2 was defined as a) LV ejection fraction (LVEF) increase ≥ 15%, or b) LVEF increase ≥ 10% plus reduction of LV end-systolic diameter index ≥ 20% or LV end-systolic volume ≥ 40%, for 12 months. Results We studied 304 patients (79.6% men, mean age 66.1 ± 12.3 years) with baseline LVEF < 40%. R2 was observed in 104 patients (34.2%). In univariable logistic regression, factors associated with R2 were age (p = 0.02), non-ischemic etiology of HF (p < 0.001), NYHA functional class (p = 0.02), baseline LVEF (p = 0.005), absence of left bundle branch block (LBBB; p = 0.002), ST2 (p = 0.004), NT-proBNP (p = 0.005), and hs-cTnT (p < 0.001); HF duration achieved borderline significance (p = 0.08). In multivariable analysis, ST2 remained the only biomarker associated with LV-R2. We developed the ST2-R2 score for use in clinical practice for predicting R2; variables included were ST2 < 48 ng/mL, non-ischemic etiology, absence of LBBB, HF duration < 12 months, baseline LVEF < 24%, and β-blocker treatment. The score had an area under the curve of 0.79 in the derivation cohort and 0.73 in a separate validation cohort. Conclusions The ST2-R2 score, which includes the novel biomarker ST2 and five clinical variables, reasonably predicts LV-R2 in systolic HF patients. ST2 was the only studied biomarker that was independently associated with R2. [ABSTRACT FROM AUTHOR]

المؤلفون: Pascual-Figal, Domingo A.¹ dapascual@servicam.com, Bonaque, Juan C.¹, Manzano-Fernández, Sergio¹, Fernández, Asunción¹, Garrido, Iris P.¹, Pastor-Perez, Francisco¹, Lax, Antonio¹, Valdes, M.¹, Januzzi, James L.²

المصدر: International Journal of Cardiology. Oct2012, Vol. 160 Issue 3, p196-200. 5p.

مصطلحات موضوعية: *ERYTHROCYTES, *HEART failure patients, *ANEMIA, *HEMOGLOBINS, *CARDIOLOGY, *BLOOD diseases

مستخلص: Abstract: Background: Hematologic abnormalities such as elevated red blood cell distribution width (RDW) as well as anemia are prognostically meaningful among heart failure (HF) patients. The inter-relationship between these hematologic abnormalities in HF is unclear, however. We therefore aimed to assess whether RDW is predicting changes in hemoglobin concentrations as well as onset of anemia. Methods: 268 consecutive non-anemic patients with acutely decompensated HF (ADHF) were enrolled at hospital discharge and RDW was measured. At 6month follow-up, change in hemoglobin as well as new-onset anemia was studied as a function of RDW at discharge. Results: RDW at discharge correlated negatively with hemoglobin values at 6months (r=−0.220; p<0.001); a greater decrease in hemoglobin concentration occurred in those with higher values of RDW at discharge (p=0.004), independently of baseline hemoglobin concentration and other risk factors. At 6months, 54 patients (20%) developed new-onset anemia. RDW values at discharge were significantly higher among patients who developed new-onset anemia (15.1±2.2 vs. 14.2±1.4, p=0.005). In integrated discrimination improvement analyses, the addition of RDW measurement improved the ability to predict new-onset anemia (IDI 0.0531, p<0.001), beyond known risk factors as hemoglobin, renal function, age, diabetes mellitus, sex and HF symptom severity. In adjusted analyses, patients with RDW>15% (derived from receiver operating characteristic analysis) had a tripling of the risk of new-onset anemia (OR=3.1, 95% CI 1.5–5.1, p=0.002). Conclusion: Among non-anemic patients with ADHF, RDW measurement at the time of hospital discharge independently predicts lower hemoglobin concentrations and new-onset anemia over a 6-month follow up period. [Copyright &y& Elsevier]