Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
ESC Heart Fail. 2022 Dec;9(6):3876-3887. doi: 10.1002/ehf2.14071. Epub 2022 Aug 8.
The Universal Definition of Heart Failure (UDHF) provides a framework for staging risk for HF events. It is not clear whether prognostic biomarkers have different meaning across UDHF stages. We sought to evaluate performance of biomarkers to predict HF events among high-risk patients undergoing coronary and/or peripheral angiography categorized into UDHF stages.
One thousand two hundred thirty-five individuals underwent coronary and/or peripheral angiography were enrolled. Study participants were categorized into UDHF Stage A (at risk), Stage B (pre-HF), and Stage C or D (HF, including end stage) and grouped into Stage A/B and C/D. Biomarkers and clinical variables were used to develop prognostic models. Other measures examined included total HF hospitalizations.
Over a median of 3.67 years of follow-up, 155 cardiovascular (CV) deaths occurred, and 299 patients were hospitalized with acute HF. In patients with Stage A/B, galectin-3 (HR = 1.52, P = 0.03), endothelin-1 (HR = 2.16, P = 0.001), and N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR = 1.43, P < 0.001) were associated with incident CV death/HF hospitalization. In Stage C/D, NT-proBNP (HR = 1.26, P = 0.006), soluble urokinase-type plasminogen activator receptor (suPAR; HR = 1.57, P = 0.007) and high-sensitivity C-reactive protein (hs-CRP; HR = 1.15, P = 0.01) were associated with these outcomes. Higher biomarker concentrations were associated with greater total burden of HF events in Stages A/B and C/D.
Among higher risk individuals undergoing angiographic procedures, different biomarkers improve risk stratification in different UDHF stages of HF. More precise prognostication may offer a window of opportunity to initiate targeted preventive measures.
心力衰竭的通用定义（UDHF）为心力衰竭事件的风险分期提供了一个框架。目前尚不清楚预后生物标志物在 UDHF 各分期中的意义是否不同。我们旨在评估生物标志物在根据 UDHF 分期分为 A（高危）、B（HF 前期）和 C 或 D（HF，包括终末期）期的高危行冠状动脉和/或外周血管造影术的患者中预测 HF 事件的性能。
共纳入 1235 名接受冠状动脉和/或外周血管造影术的患者。研究参与者被分为 UDHF 阶段 A（高危）、阶段 B（HF 前期）和阶段 C 或 D（HF，包括终末期），并分为阶段 A/B 和 C/D。生物标志物和临床变量用于开发预测模型。其他检查措施包括总 HF 住院次数。
在中位随访 3.67 年期间，发生 155 例心血管（CV）死亡，299 例患者因急性 HF 住院。在阶段 A/B 的患者中，半乳糖凝集素-3（HR=1.52，P=0.03）、内皮素-1（HR=2.16，P=0.001）和 N 末端 B 型利钠肽前体（NT-proBNP；HR=1.43，P<0.001）与 CV 死亡/HF 住院的发生相关。在阶段 C/D 的患者中，NT-proBNP（HR=1.26，P=0.006）、可溶性尿激酶型纤溶酶原激活物受体（suPAR；HR=1.57，P=0.007）和高敏 C 反应蛋白（hs-CRP；HR=1.15，P=0.01）与这些结果相关。在阶段 A/B 和 C/D 中，更高的生物标志物浓度与 HF 事件的总负担增加相关。
在接受血管造影术的高危人群中，不同的生物标志物在 HF 的不同 UDHF 分期中改善风险分层。更精确的预后预测可能为启动有针对性的预防措施提供机会之窗。
