PMID- 36544337 OWN - NLM STAT- MEDLINE DCOM- 20230125 LR - 20230125 IS - 2234-3814 (Electronic) IS - 2234-3806 (Print) IS - 2234-3806 (Linking) VI - 43 IP - 3 DP - 2023 May 1 TI - Prognostic Value of Combined Biomarkers in Patients With Heart Failure: The Heartmarker Score. PG - 253-262 LID - 10.3343/alm.2023.43.3.253 [doi] AB - BACKGROUND: Heart failure (HF) biomarkers have prognostic value. The aim of this study was to combine HF biomarkers into an objective classification system for risk stratification of patients with HF. METHODS: HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off values (N-terminal pro-B-type natriuretic peptide [NT-proBNP] >1,000 pg/mL, soluble suppression of tumorigenesis-2 [ST2] >35 ng/mL, growth differentiation factor-15 [GDF-15] >2,000 pg/mL, and fibroblast growth factor-23 [FGF-23] >95.4 pg/mL). Biomarkers that remained significant in multivariable analysis were combined to devise the Heartmarker score. The performance of the Heartmarker score was compared to the widely used New York Heart Association (NYHA) classification based on symptoms during ordinary activity. RESULTS: HF biomarkers of 245 patients were analyzed, 45 (18%) of whom experienced the composite endpoint of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. HF biomarkers were elevated more often in patients that reached the composite endpoint than in patients that did not reach the endpoint. NT-proBNP, ST2, and GDF-15 were independent predictors of the composite endpoint and were thus combined as the Heartmarker score. The event-free survival and distance covered in 6 minutes of walking decreased with an increasing Heartmarker score. Compared with the NYHA classification, the Heartmarker score was better at discriminating between different risk classes and had a comparable relationship to functional capacity. CONCLUSIONS: The Heartmarker score is a reproducible and intuitive model for risk stratification of outpatients with HF, using routine biomarker measurements. FAU - van der Stam, Jonna A AU - van der Stam JA AUID- ORCID: 0000-0002-6195-7303 AD - Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. AD - Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. AD - Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands. FAU - Bouwmeester, Sjoerd AU - Bouwmeester S AUID- ORCID: 0000-0002-8358-2231 AD - Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands. FAU - van Loon, Saskia L M AU - van Loon SLM AUID- ORCID: 0000-0001-9546-872X AD - Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. AD - Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands. FAU - van Riel, Natal A W AU - van Riel NAW AUID- ORCID: 0000-0001-9375-4730 AD - Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. AD - Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands. AD - Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands. FAU - Dekker, Lukas R AU - Dekker LR AUID- ORCID: 0000-0002-8166-3716 AD - Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands. AD - Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. FAU - Boer, Arjen-Kars AU - Boer AK AUID- ORCID: 0000-0002-2667-1027 AD - Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. AD - Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. AD - Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands. FAU - Houthuizen, Patrick AU - Houthuizen P AUID- ORCID: 0000-0001-9313-3344 AD - Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands. FAU - Scharnhorst, Volkher AU - Scharnhorst V AUID- ORCID: 0000-0002-1243-9251 AD - Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. AD - Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. AD - Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands. LA - eng PT - Journal Article DEP - 20221222 PL - Korea (South) TA - Ann Lab Med JT - Annals of laboratory medicine JID - 101571172 RN - 0 (Biomarkers) RN - 0 (Growth Differentiation Factor 15) RN - 0 (Interleukin-1 Receptor-Like 1 Protein) RN - 114471-18-0 (Natriuretic Peptide, Brain) RN - 0 (Peptide Fragments) RN - 0 (FGF23 protein, human) RN - 7Q7P4S7RRE (Fibroblast Growth Factor-23) RN - 0 (pro-brain natriuretic peptide (1-76)) SB - IM MH - Humans MH - Biomarkers MH - Growth Differentiation Factor 15/blood/chemistry MH - *Heart Failure/diagnosis MH - Interleukin-1 Receptor-Like 1 Protein MH - Natriuretic Peptide, Brain/blood/chemistry MH - Peptide Fragments MH - Prognosis MH - Fibroblast Growth Factor-23/blood/chemistry PMC - PMC9791008 OTO - NOTNLM OT - Biomarkers OT - Growth differentiation factor-15 OT - Heart failure OT - N-terminal pro-B-type natriuretic peptide OT - Soluble suppression of tumorigenesis-2 COIS- CONFLICTS OF INTEREST Some reagents for laboratory analysis were provided free of charge by Roche Diagnostics Nederland BV. Volkher Scharnhorst incidentally acts as a clinical consultant on advisory boards for Roche Diagnostics Nederland BV, and the associated fees are paid to the hospital. EDAT- 2022/12/23 06:00 MHDA- 2022/12/24 06:00 PMCR- 2022/12/22 CRDT- 2022/12/22 01:05 PHST- 2022/07/21 00:00 [received] PHST- 2022/09/06 00:00 [revised] PHST- 2022/11/07 00:00 [accepted] PHST- 2022/12/22 01:05 [entrez] PHST- 2022/12/23 06:00 [pubmed] PHST- 2022/12/24 06:00 [medline] PHST- 2022/12/22 00:00 [pmc-release] AID - alm.2023.43.3.253 [pii] AID - alm-43-3-253 [pii] AID - 10.3343/alm.2023.43.3.253 [doi] PST - ppublish SO - Ann Lab Med. 2023 May 1;43(3):253-262. doi: 10.3343/alm.2023.43.3.253. Epub 2022 Dec 22.