1
|
Álvarez-García J, García-Osuna Á, Vives-Borrás M, Ferrero-Gregori A, Martínez-Sellés M, Vázquez R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Bascompte R, Delgado J, Grau Sepúlveda A, Bardají A, Pérez-Villa F, Zamorano JL, Crespo-Leiro M, Sánchez PL, Ordoñez-Llanos J, Cinca J. A 3-Biomarker 2-Point-Based Risk Stratification Strategy in Acute Heart Failure. Front Physiol 2021; 12:708890. [PMID: 34744758 PMCID: PMC8569896 DOI: 10.3389/fphys.2021.708890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/04/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715-0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747-0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.
Collapse
Affiliation(s)
- Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Álvaro García-Osuna
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Barcelona, Spain
| | - Miquel Vives-Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Puerta del Mar, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Cádiz, Spain
| | - José R González-Juanatey
- Cardiology Department, Hospital Clínico, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, Hospital La Fe, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Puerta de Hierro-Majadahonda, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Murcia, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ramón Bascompte
- Cardiology Department, Hospital Arnau de Vilanova, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Lleida, Spain
| | - Juan Delgado
- Cardiology Department, Hospital 12 de Octubre, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andrés Grau Sepúlveda
- Cardiology Department, Hospital Universitario Son Espases, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Palma de Mallorca, Spain
| | - Alfredo Bardají
- Cardiology Department, Hospital Juan XXIII, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Tarragona, Spain
| | - Félix Pérez-Villa
- Cardiology Department, Hospital Clinic, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - José Luis Zamorano
- Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marisa Crespo-Leiro
- Cardiology Department, Hospital Universitario A Coruna, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), A Coruna, Spain
| | - Pedro Luis Sánchez
- Cardiology Department, Hospital Clínico Universitario, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Jordi Ordoñez-Llanos
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| |
Collapse
|
2
|
de Frutos F, Mirabet S, Ortega-Paz L, Buera I, Darnés S, Farré N, Perez B, Adeliño R, Bascompte R, Pérez-Rodón J, Aparicio X, Sutil-Vega M, Soto A, Faraudo M, Cainzos-Achirica M, Manito N. Management of Heart Failure with Reduced Ejection Fraction after ESC 2016 Heart Failure Guidelines: The Linx Registry. ESC Heart Fail 2020; 7:25-35. [PMID: 31916413 PMCID: PMC7083472 DOI: 10.1002/ehf2.12567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
Aims In May 2016, a new version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) was released. The aim of this study was to describe the management of HF with reduced ejection fraction after the publication of ESC Guidelines. Methods and results The Linx registry is a multicentre, observational, cross‐sectional study from 14 Catalan hospitals that enrolled 1056 patients with HF and reduced left ventricular ejection fraction (≤40%) from 1 February to 30 April 2017 in outpatient cardiology clinics. Results were compared between hospitals according to their level of complexity in our own registry and compared with previously published registries similar to ours. Sacubitril/valsartan was prescribed to 23.9% of patients in our population, as a consequence, use of angiotensin‐converting enzyme inhibitor and angiotensin receptor blockers in monotherapy decreased to 48.1% and 16.9%, respectively, and prescription of beta‐blockers (91.8%), mineralocorticoid receptor antagonists (72.7%), and ivabradine (21.4%) remained similar to previous registries. Target doses of beta‐blockers (25.4%), angiotensin‐converting enzyme inhibitors (24.9%), angiotensin receptor blockers (7.7%), sacubitril/valsartan (8.1%), and mineralocorticoid receptor antagonists (19.7%) were accomplished in a low proportion of patients. Our results also suggest that prescription and up‐titration of class I HF drugs were greater in hospitals with higher level of complexity. Conclusions The Linx registry shows an appropriate adherence to pharmacological recommendations from ESC HF Guidelines despite a low proportion of patients reached target doses. Almost one‐quarter of patients were under treatment with sacubitril/valsartan a few months after ESC HF Guidelines recommendations.
Collapse
Affiliation(s)
- Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Sonia Mirabet
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Irene Buera
- Department of Cardiology, Hospital de Viladecans, Barcelona, Spain
| | - Sara Darnés
- Department of Cardiology, Hospital de Figueres, Girona, Spain
| | - Nuria Farré
- Department of Cardiology, Hospital del Mar, Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), and Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bernardo Perez
- Department of Cardiology, Hospital de Granollers, Barcelona, Spain
| | - Raquel Adeliño
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Ramón Bascompte
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jordi Pérez-Rodón
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Institut de Recerca, CIBER-CV, Barcelona, Spain
| | - Xavier Aparicio
- Department of Cardiology, Hospital de Mataró, Barcelona, Spain
| | - Mario Sutil-Vega
- Department of Cardiology, Corporacio Sanitaria Parc Taulí, Barcelona, Spain
| | - Adriana Soto
- Department of Cardiology, Hospital de Martorell, Barcelona, Spain
| | - Mercedes Faraudo
- Department of Cardiology, Hospital Moises Broggi, Barcelona, Spain
| | | | - Nicolás Manito
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| |
Collapse
|
3
|
Sole Gonzalez E, Ferrero-Gregori A, Puig T, Alvarez-Garcia J, Vives-Borras M, Vazquez R, Delgado J, Pascual-Figal D, Gonzalez-Juanatey J, Bardaji A, Bascompte R, Roig E, Cinca J. P5256Role of pathophysiological cardiac substrate on prognosis of ambulatory patients with chronic heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E. Sole Gonzalez
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - A. Ferrero-Gregori
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - T. Puig
- Hospital de la Santa Creu i Sant Pau, Epidemiology and Public Health Department, Barcelona, Spain
| | - J. Alvarez-Garcia
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - M. Vives-Borras
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - R. Vazquez
- University Hospital Puerta del Mar, Cardiology Department, Cadiz, Spain
| | - J. Delgado
- University Hospital 12 de Octubre, Cardiology Department, Madrid, Spain
| | - D. Pascual-Figal
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology Department, Murcia, Spain
| | - J.R. Gonzalez-Juanatey
- University Hospital of Santiago de Compostela, Cardiology Department, Santiago de Compostela, Spain
| | - A. Bardaji
- Hospital Universitario Joan XXIII, Cardiology Department, Tarragona, Spain
| | - R. Bascompte
- Hospital Arnau de Vilanova, Cardiology Department, Lleida, Spain
| | - E. Roig
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - J. Cinca
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | | |
Collapse
|