PMID- 25563469
OWN - NLM
STAT- MEDLINE
DCOM- 20170223
LR  - 20170223
IS  - 1897-4279 (Electronic)
IS  - 0022-9032 (Linking)
VI  - 73
IP  - 6
DP  - 2015
TI  - Old markers, new approach to assessment of risk in heart failure.
PG  - 387-95
AB  - BACKGROUND: Heart transplantation (HTx) is still the optimal treatment for 
      refractory heart failure (HF). However, there is great disproportion between the 
      number of donors and potential recipients. Several parameters are used in patient 
      evaluation before HTx, but the qualification process still requires improvement. 
      High-sensitivity C-reactive protein (hsCRP) and N-terminal pro-B-type natriuretic 
      peptide (NT-proBNP) possess high prognostic value for patients with advanced HF. 
      AIM: To assess the prognostic significance of NT-proBNP and hsCRP separately, as 
      well as in combination, in a group of patients with advanced HF, considered for 
      HTx. METHODS: Registry - 632 patients referred for HTx in Poland (2003-2007). 
      Following proper treatment correction and routine clinical evaluation (i.e. mean 
      New York Heart Association [NYHA] classification 3.2 +/- 0.6, heart rate 77 +/- 15 
      bpm, systolic/diastolic blood pressure [SBP/DBP] 103/67 +/- 15/11 mm Hg, left 
      ventricular ejection fraction [LVEF] 22 +/- 8%, serum Na+ 136 +/- 4 mmol/L, NT-proBNP 
      3942 +/- 5637 pg/mL, hsCRP 9 +/- 22 mg/L levels, HFSS according to Aaronson 8 +/- 1, 
      etc.) patients were qualified for HTx. Based on ROC analysis (cut-off points for 
      NT-proBNP 2435 pg/mL and hsCRP 2.4 mg/L) subjects were stratified into four 
      subgroups: (1) non-elevated hsCRP (-)/NT-proBNP (-) (n = 179); (2) non-elevated 
      hsCRP (-)/ /elevated NT-proBNP (+) (n = 92); (3) elevated hsCRP (+)/non-elevated 
      NT-proBNP (-) (n = 159); and (4) elevated hsCRP (+)/ /NT-proBNP (+) (n = 202). 
      The end point was defined as death/urgent HTx. The mean follow-up period was 601 
      days. RESULTS: In univariate regression analysis we confirmed that classical risk 
      factors were independent predictors of end point: NYHA (HR = 2.311; p < 0.0001), 
      heart rate (HR = 1.016; p = 0.0009), SBP (HR = 0.984; p = 0.0111), LVEF (HR = 
      0.951; p < 0.0001), serum Na+ (HR = 0.901; p < 0.0001), NT-proBNP (HR = 1.004; p 
      = 0.0159), and hsCRP (HR = 1.010; p = 0.0002); HFSS (HR = 0.557; p < 0.0001). 
      Frequency-of-events analysis revealed that patients in the hsCRP (-)/ /NT-proBNP 
      (-) subgroup presented with the best prognosis (13% of patients reached end 
      point) followed by the hsCRP (-)/ /NT-proBNP (+) subgroup, in which 24% of 
      patients reached end point (Kaplan-Meier c2 = 8.5319; p = 0.0035) and the hsCRP 
      (+)/NT-proBNP (+) subgroup (c2 = 42.0413; p < 0.0001), which was associated with 
      the worst prognosis (39% of patients reached end point). CONCLUSIONS: The 
      classical risk factors: NYHA class, heart rate, SBP, LVEF, HFSS, serum Na+, 
      NT-proBNP, and hsCRP concentrations, proved to be valuable in the assessment of 
      risk in advanced HF patients. However, concomitant evaluation of old markers: 
      hsCRP and NT-proBNP, may become a good prognostic tool for identification of 
      highest-risk patients among all referred for HTx. Such a new approach to risk 
      stratification before HTx seems promising but requires further investigation.
FAU - Kodziszewska, Katarzyna
AU  - Kodziszewska K
FAU - Leszek, Przemyslaw
AU  - Leszek P
FAU - Korewicki, Jerzy
AU  - Korewicki J
FAU - Piotrowski, Walerian
AU  - Piotrowski W
LA  - eng
PT  - Journal Article
PL  - Poland
TA  - Kardiol Pol
JT  - Kardiologia polska
JID - 0376352
RN  - 0 (Biomarkers)
RN  - 0 (Peptide Fragments)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Adult
MH  - Biomarkers/*blood
MH  - C-Reactive Protein/*analysis
MH  - Heart Failure/blood/*diagnosis
MH  - Heart Transplantation
MH  - Humans
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*blood
MH  - Peptide Fragments/*blood
MH  - Prognosis
MH  - Risk Factors
EDAT- 2015/01/08 06:00
MHDA- 2017/02/24 06:00
CRDT- 2015/01/08 06:00
PHST- 2014/08/06 00:00 [received]
PHST- 2014/10/23 00:00 [accepted]
PHST- 2014/09/15 00:00 [revised]
PHST- 2015/01/08 06:00 [entrez]
PHST- 2015/01/08 06:00 [pubmed]
PHST- 2017/02/24 06:00 [medline]
AID - VM/OJS/KP/9019 [pii]
AID - 10.5603/KP.a2014.0245 [doi]
PST - ppublish
SO  - Kardiol Pol. 2015;73(6):387-95. doi: 10.5603/KP.a2014.0245.