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Kadoglou NPE, Bouwmeester S, de Lepper AGW, de Kleijn MC, Herold IHF, Bouwman ARA, Korakianitis I, Simmers T, Bracke FALE, Houthuizen P. The Prognostic Role of Global Longitudinal Strain and NT-proBNP in Heart Failure Patients Receiving Cardiac Resynchronization Therapy. J Pers Med 2024; 14:188. [PMID: 38392621 PMCID: PMC10890173 DOI: 10.3390/jpm14020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/15/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND We aimed to evaluate whether baseline GLS (global longitudinal strain), NT-proBNP, and changes in these after cardiac resynchronization therapy (CRT) can predict long-term clinical outcomes and the echocardiographic-based response to CRT (defined by 15% relative reduction in left ventricular end-systolic volume). METHODS We enrolled 143 patients with stable ischemic heart failure (HF) undergoing CRT-D implantation. NT-proBNP and echocardiography were obtained before and 6 months after. The patients were followed up (median: 58 months) for HF-related deaths and/or HF hospitalizations (primary endpoint) or HF-related deaths (secondary endpoint). RESULTS A total of 84 patients achieved the primary and 53 the secondary endpoint, while 104 patients were considered CRT responders and 39 non-responders. At baseline, event-free patients had higher absolute GLS values (p < 0.001) and lower NT-proBNP serum levels (p < 0001) than those achieving the primary endpoint. A similar pattern was observed in favor of CRT responders vs. non-responders. On Cox regression analysis, baseline absolute GLS value (HR = 0.77; 95% CI, 0.51-1.91; p = 0.002) was beneficially associated with lower primary endpoint incidence, while baseline NT-proBNP levels (HR = 1.55; 95% CI, 1.43-2.01; p = 0.002) and diabetes presence (HR = 1.27; 95% CI, 1.12-1.98; p = 0.003) were related to higher primary endpoint incidence. CONCLUSIONS In HF patients undergoing CRT-D, baseline GLS and NT-proBNP concentrations may serve as prognostic factors, while they may predict the echocardiographic-based response to CRT.
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Affiliation(s)
| | - Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | - Anouk G W de Lepper
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | - Marloes C de Kleijn
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | - Ingeborg H F Herold
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | - Arthur R A Bouwman
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | | | - Tim Simmers
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | - Franke A L E Bracke
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, 5623 Eindhoven, The Netherlands
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Fields KG, Ma J, Petrinic T, Alhassan H, Eze A, Reddy A, Hedayat M, Providencia R, Lip GYH, Bedford JP, Clifton DA, Redfern OC, O'Brien B, Watkinson PJ, Collins GS, Muehlschlegel JD. Multivariable prediction models for atrial fibrillation after cardiac surgery: a systematic review protocol. BMJ Open 2023; 13:e067260. [PMID: 36914189 PMCID: PMC10016290 DOI: 10.1136/bmjopen-2022-067260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Dozens of multivariable prediction models for atrial fibrillation after cardiac surgery (AFACS) have been published, but none have been incorporated into regular clinical practice. One of the reasons for this lack of adoption is poor model performance due to methodological weaknesses in model development. In addition, there has been little external validation of these existing models to evaluate their reproducibility and transportability. The aim of this systematic review is to critically appraise the methodology and risk of bias of papers presenting the development and/or validation of models for AFACS. METHODS We will identify studies that present the development and/or validation of a multivariable prediction model for AFACS through searches of PubMed, Embase and Web of Science from inception to 31 December 2021. Pairs of reviewers will independently extract model performance measures, assess methodological quality and assess risk of bias of included studies using extraction forms adapted from a combination of the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and the Prediction Model Risk of Bias Assessment Tool. Extracted information will be reported by narrative synthesis and descriptive statistics. ETHICS AND DISSEMINATION This systemic review will only include published aggregate data, so no protected health information will be used. Study findings will be disseminated through peer-reviewed publications and scientific conference presentations. Further, this review will identify weaknesses in past AFACS prediction model development and validation methodology so that subsequent studies can improve upon prior practices and produce a clinically useful risk estimation tool. PROSPERO REGISTRATION NUMBER CRD42019127329.
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Affiliation(s)
- Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jie Ma
- Centre for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tatjana Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Hassan Alhassan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anthony Eze
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ankith Reddy
- University of Texas Medical Branch, School of Medicine, Galveston, Texas, USA
| | - Mona Hedayat
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jonathan P Bedford
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Oliver C Redfern
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Benjamin O'Brien
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Perioperative Medicine, St. Bartholomew's Hospital and Barts Heart Centre, Barts Health NHS Trust, London, UK
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
- NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Kadoglou NPE, Parissis J, Karavidas A, Kanonidis I, Trivella M. Assessment of acute heart failure prognosis: the promising role of prognostic models and biomarkers. Heart Fail Rev 2021; 27:655-663. [PMID: 34036472 DOI: 10.1007/s10741-021-10122-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
Numerous models and biomarkers have been proposed to estimate prognosis and improve decision-making in patients with acute heart failure (AHF). The present literature review provides a critical appraisal of externally validated prognostic models in AHF, combining clinical data and biomarkers. We perform a literature review of clinical studies, using the following terms: "acute heart failure," "acute decompensated heart failure," "prognostic models," "risk scores," "mortality," "death," "hospitalization," "admission," and "biomarkers." We searched MEDLINE and EMBASE databases from 1990 to 2020 for studies documenting prognostic models in AHF. External validation of each prognostic model to another AHF cohort, containing at least one biomarker, was prerequisites for study selection. Among 358 initially screened studies, 9 of them fulfilled all searching criteria. The majority of prognostic models were simplified, including a narrow number of variables (up to 10), with good performance regarding calibration and discrimination (c-statistics > 0.65). Unfortunately, the derived and validated cohorts showed a wide variety in patients' characteristics (e.g., cause of AHF and therapy). Moreover, the prognostic models used various time-points and a plethora of combinations of variables determining different cut-off values. Although the application of valid prognostic models in AHF population is quite promising, a precise methodological approach should be set for the derivation and validation of prognostic models in AHF with unified characteristics to establish an effective performance in clinical practice.
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Affiliation(s)
- Nikolaos P E Kadoglou
- Medical School, University of Cyprus, 215/6 Old road Lefkosias-Lemesou, 2029, Aglantzia, Nicosia, Cyprus.
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
| | - John Parissis
- 2nd Department of Cardiology, Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Kanonidis
- Second Cardiology Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marialena Trivella
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
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Lichtenauer M, Jirak P, Paar V, Sipos B, Kopp K, Berezin AE. Heart Failure and Diabetes Mellitus: Biomarkers in Risk Stratification and Prognostication. APPLIED SCIENCES 2021; 11:4397. [DOI: 10.3390/app11104397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Heart failure (HF) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular (CV) morbidity and mortality in patients with established CV disease (CVD). The aim of this review is to summarize the knowledge regarding the discriminative abilities of conventional and novel biomarkers in T2DM patients with established HF or at higher risk of developing HF. While conventional biomarkers, such as natriuretic peptides and high-sensitivity troponins demonstrate high predictive ability in HF with reduced ejection fraction (HFrEF), this is not the case for HF with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous disease with a high variability of CVD and conventional risk factors including T2DM, hypertension, renal disease, older age, and female sex; therefore, the extrapolation of predictive abilities of traditional biomarkers on this population is constrained. New biomarker-based approaches are disputed to be sufficient for improving risk stratification and the prediction of poor clinical outcomes in patients with HFpEF. Novel biomarkers of biomechanical stress, fibrosis, inflammation, oxidative stress, and collagen turn-over have shown potential benefits in determining prognosis in T2DM patients with HF regardless of natriuretic peptides, but their role in point-to-care and in routine practice requires elucidation in large clinical trials.
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