Can Classic Biomarkers be Prognosticators in Heart Failure? - Data from the REFERENCE study

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Neglected hematological parameters in heart failure prognosis – Disclosures from the REFERENCE study

Aims: In heart failure patients, anemia and iron deficiency are predictors of poor outcome. We studied the association of anemia, iron deficiency and related hematological parameters with short-term rehospitalization, short-term all-cause mortality and end of follow-up all-cause mortality in heart failure patients. Material and Methods: Anemia, iron deficiency, red cell distribution width and erythropoietin were assessed in patients hospitalized with acute decompensated heart failure. Univariate Cox proportional hazard model was used to assess the relationship between variables and outcomes. Results: 65 patients were followed for a median of 13.7 (Q1-Q3 6.7-18.9) months. Mean age was 79.2 (SD 10.8) years. The mean left ventricular ejection fraction was 50.38 ± 19.07 %. Variables associated with an increased risk for short-term rehospitalization were red cell distribution width (HR 1.35; 95% CI 1.16- 1.58), anemia (HR 3.81; 95% CI 1.29-11.28) and anemia with iron deficiency (HR 3.50; 95% CI 1.30-9.38). Increased risk for short-term mortality was associated with red cell distribution width (HR 1.83; 95% CI 1.29-2.59), erythropoietin (HR 1.38; 95% CI 1.04-1.82), absolute iron deficiency (HR 7.22; 95% CI 1.50-34.81) and anemia with iron deficiency (HR 4.48; 95% CI 1.26-15.88). Variables associated with increased risk for end of follow-up mortality were red cell distribution width (HR 1.31; 95% CI 1.12-1.54) and erythropoietin (HR 1.29; 95% CI 1.11-1.49). Conclusions: Conclusions: Anemia and red cell distribution width correlated with higher risk for short-term rehospitalization. Absolute iron deficiency, red cell distribution width and erythropoietin were associated with higher risk for short-term mortality. Red cell distribution width and erythropoietin were associated with higher risk for end of follow-up mortality.info:eu-repo/semantics/publishedVersio

Insights from the pREdictors oF Early REadmission iN Chronic hEart failure (REFERENCE) Study

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Gal-3 and ST2 Biomarkers - A Step Forward in Heart Failure Prognostication

Aims: The American College of Cardiology (ACA)/ American Heart Association (AHA) granted Galectin-3 (Gal-3) and Suppression of Tumorigenicity 2 (ST2) evaluation a class II recommendation for HF prognosis, as an adjunctive to conventional clinical risk factors and natriuretic peptides dosing in 2013. However, in Europe this endorsement is not valid. The purpose of this study was to study the association of Gal-3 and ST2 collected at-admission with early (defined as the period of 90 days post-discharge) rehospitalization and overall mortality, and end of follow-up overall mortality in HF patients. Additionally, aminoterminal B-type natriuretic peptide (NT-proBNP) at admission was considered to test if a multi-marker strategy could yield supplementary information. Material and Methods: Gal-3, ST2 and NT-proBNP were assessed in patients hospitalized with acute decompensated HF in class III or IV of New York Heart Association (NYHA). Univariate Cox proportional hazard model was used to assess the relationship between variables and outcomes. Since there are no standardized cut-offs for Gal-3 and ST2, the multiclass Area Under the Curve Receiver-Operator Characteristic (AUCROC) as defined by Hand and Till was used to evaluate the overall performance of each biomarker as a predictor of the outcomes. Results: We followed 65 patients for a median of 13.7 (Q1-Q3 6.7-18.9) months. Gal-3 correlated with short-term rehospitalization (HR: 9.886, 95% CI: 2.027-48.214, P-value=0.005), short-term mortality (HR: 13.731, 95% CI: 1.650-114.276, P value=0.015) and end of follow-up mortality (HR: 4.492, 95% CI: 1.594-12.656, P-value=0.004). The association of elevated NT-proBNP determinations increased the risk of short-term rehospitalization (HR: 11.985, 95% CI: 1.962-73.218, P value=0.007) and end of follow-up mortality (HR: 78.025, 95% CI: 7.592-801.926, P-value<0.001). ST2 correlated with end of follow-up mortality (HR: 4.846, 95% CI: 1.396-16.825, P-value=0.013). The risk further increased if NT-proBNP (HR: 5.953, 95% CI: 1.683- 21.055, P-value=0.006) or Gal-3 determinations (HR: 6.209, 95% CI: 2.393-16.114, P-value<0.001) were added. Conclusions: Elevated Gal-3 concentrations correlated with short-term rehospitalization, short-term mortality and end of follow-up mortality; whereas ST2 prognosticated end of follow-up mortality. Collective analysis with elevated NT-proBNP values further increased the outcomes’ risk. These results corroborate the assumption that promising novel biomarkers Gal-3 and ST2 could be valuable for HF risk stratification. We highlight that a multi-marker strategy added information, as a synergism between myocardial fibrosis biomarkers and the myocardial stretch peptide was observed.info:eu-repo/semantics/publishedVersio

Is Bundle Branch Block useful in Heart Failure Risk Stratification? - Disclosures from the REFERENCE study

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Disruption of balance of oxidative stress-associated angiogenesis in heart failure

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The Impact of Low Blood Pressure in Heart Failure Outcome - Results from the REFERENCE study

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The Paramount Importance of Renal Function in Heart Failure Prognosis - Conclusions from the REFERENCE study

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The Complementary Role of Novel Cardiac Fibrosis Biomarkers in Heart Failure Prognosis - A report from the REFERENCE study

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The importance of hematological parameters in heart failure prognosis - evidence from the REFERENCE Study

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