Biomarkers to Improve Prognostication in Heart Failure

Abstract

The course of heart failure is difficult to predict. Biomarkers could help us to improve predicting outcome. Therefore, we initiated the TRIUMPH study in which nearly 500 patients with acute heart failure from 14 Dutch hospitals were followed for one year. During this period we collected clinical data and seven blood samples to evaluate known and unknown biomarkers. We found that repeated measurements of both ST2 and galectin-3 were independent predictors of heart failure re-admission and death, independent of known risk factors and repeated NT-proBNP measurements, which is currently a widely used biomarker in patients with heart failure. In the second part of this thesis, the TRIUMPH population investigated whether there is a relationship between the quality of life and different comorbidities, the presence of other diseases such as previous stroke, renal dysfunction, diabetes mellitus and COPD. We saw that patients with co-morbidities experience a poorer quality of life. In addition, it was noted that patients with heart failure often suffer from symptoms and that this is even more common in heart failure patients with depressive complaints. Finally, we performed a meta-analysis to see whether RAAS inhibitors, a blood pressure lowering agent, improve survival in patients with hypertension. Data from nearly 160,000 patients were collected for an average of four years. During this period, there was a 5% decrease in death compared to using other contemporary blood pressure lowering medication or placebo. This is an important finding as hypertension is one of the most common diseases worldwide