Cardiovascular and non-cardiovascular death distinction: the utility of troponin beyond N-terminal pro-B-type natriuretic peptide. Findings from the BIOSTAT-CHF study.
Cardiovascular death
Events
Heart failure
Natriuretic peptides
Non-cardiovascular death
Risk
Troponin
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
13
06
2019
revised:
24
09
2019
accepted:
27
09
2019
pubmed:
4
12
2019
medline:
18
5
2021
entrez:
4
12
2019
Statut:
ppublish
Résumé
Heart failure (HF) patients are at high-risk of cardiovascular (CV) events, including CV death. Nonetheless, a substantial proportion of these patients die from non-CV causes. Identifying patients at higher risk for each individual event may help selecting patients for clinical trials and tailoring cardiovascular therapies. The aims of the present study are to: (i) characterize patients according to CV vs. non-CV death; (ii) develop models for the prediction of the respective events; (iii) assess the models' performance to differentiate CV from non-CV death. This study included 2309 patients with HF from the BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) study. Competing-risk models were used to assess the best combination of variables associated with each cause-specific death. Results were validated in an independent cohort of 1738 HF patients. The best model to predict CV death included low blood pressure, estimated glomerular filtration rate ≤ 60 mL/min, peripheral oedema, previous HF hospitalization, ischaemic HF, chronic obstructive pulmonary disease, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin (c-index = 0.73). The non-CV death model incorporated age > 75 years, anaemia and elevated NT-proBNP (c-index = 0.71). Both CV and non-CV death rose by quintiles of the risk scores; yet these models allowed the identification of patients in whom absolute CV death rates clearly outweigh non-CV death ones. These findings were externally replicated, but performed worse in a less severely diseased population. Risk models for predicting CV and non-CV death allowed the identification of patients at higher absolute risk of dying from CV causes (vs. non-CV ones). Troponin helped in predicting CV death only, whereas NT-proBNP helped in the prediction of both CV and non-CV death. These findings can be useful both for tailoring therapies and for patient selection in HF trials in order to attain CV event enrichment.
Substances chimiques
Biomarkers
0
Peptide Fragments
0
Troponin
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
81-89Subventions
Organisme : European Commission
ID : FP7-242209-BIOSTAT-CHF
Pays : International
Organisme : European Commission
ID : EudraCT 2010-020808-29
Pays : International
Organisme : French National Research Agency Fighting Heart Failure
ID : ANR-15-RHU-0004
Pays : International
Organisme : French PIA project 'Lorraine Université d'Excellence' GEENAGE
ID : ANR-15-IDEX-04-LUE
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.
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