McGranaghan Peter, Düngen Hans-Dirk, Saxena Anshul, Rubens Muni, Salami Joseph, Radenkovic Jasmin, Bach Doris, Apostolovic Svetlana, Loncar Goran, Zdravkovic Marija, Tahirovic Elvis, Veskovic Jovan, Störk Stefan, Veledar Emir, Pieske Burkert, Edelmann Frank, Trippel Tobias Daniel
Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.
Baptist Health South Florida, Coral Gables, FL, USA.
ESC Heart Fail. 2020 Oct;7(5):3029-3039. doi: 10.1002/ehf2.12928. Epub 2020 Aug 28.
The Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite-based biomarkers that has shown to improve the diagnostic value of N terminal pro B type natriuretic peptide (NT-proBNP). However, little is known about its usefulness in predicting outcomes. In this study, we developed a risk score for 4-year cardiovascular death in elderly chronic heart failure (CHF) patients using the CLP.
From the Cardiac Insufficiency Bisoprolol Study in Elderly trial, we included 280 patients with CHF aged >65 years. A targeted metabolomic analysis of the CLP biomarkers was performed on baseline serum samples. Cox regression was used to determine the association of the biomarkers with the outcome after accounting for established risk factors. A risk score ranging from 0 to 4 was calculated by counting the number of biomarkers above the cut-offs, using Youden index. During the mean (standard deviation) follow-up period of 50 (8) months, 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve for the model based on clinical variables was 0.84, the second model with NT-proBNP was 0.86, and the final model with the CLP was 0.90. The categorical net reclassification index was 0.25 using three risk categories: 0-60% (low), 60-85% (intermediate), and >85% (high). The continuous net reclassification index was 0.772, and the integrated discrimination index was 0.104.
In patients with CHF, incorporating a panel of three metabolite-based biomarkers into a risk score improved the prognostic utility of NT-proBNP by predicting long-term cardiovascular death more precisely. This novel approach holds promise to improve clinical risk assessment in CHF patients.
心脏脂质检测指标（CLP）是一组新发现的基于代谢物的生物标志物，已显示出可提高N末端B型利钠肽原（NT-proBNP）的诊断价值。然而，关于其在预测预后方面的作用知之甚少。在本研究中，我们利用CLP为老年慢性心力衰竭（CHF）患者建立了一个4年心血管死亡风险评分。
从老年心脏功能不全比索洛尔研究试验中，我们纳入了280例年龄大于65岁的CHF患者。对基线血清样本进行了CLP生物标志物的靶向代谢组学分析。在考虑已确定的危险因素后，采用Cox回归确定生物标志物与预后的关联。使用约登指数，通过计算高于临界值的生物标志物数量，计算出一个范围为0至4的风险评分。在平均（标准差）50（8）个月的随访期内，35例（18%）受试者达到心血管死亡的主要终点。基于临床变量的模型的受试者工作特征曲线下面积为0.84，包含NT-proBNP的第二个模型为0.86，包含CLP的最终模型为0.90。使用三个风险类别：0 - 60%（低）、60 - 85%（中）和>85%（高），分类净重新分类指数为0.25。连续净重新分类指数为0.772，综合判别指数为0.104。
在CHF患者中，将一组三种基于代谢物的生物标志物纳入风险评分，通过更精确地预测长期心血管死亡，提高了NT-proBNP的预后效用。这种新方法有望改善CHF患者的临床风险评估。
