Additive Value of Biomarkers and Echocardiography to Stratify the Risk of Death in Heart Failure Patients with Reduced Ejection Fraction

Abstract EN

Background.

Risk stratification is a crucial issue in heart failure.

Clinicians seek useful tools to tailor therapies according to patient risk.

Methods.

A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF).

Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected.

Association with death for any cause was analyzed.

Results.

Four hundred thirty-one (431) consecutive patients were enrolled in the study.

Fifty deaths occurred over a median follow-up of 32 months.

On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death.

Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group.

The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men.

Conclusions.

In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.