Bjurman, C; Holmström, A; Petzold, M; Hammarsten, O; Fu, ML
BACKGROUND: Due to increasing co-morbidity associated with aging, heart failure (HF) has become more prevalent and heterogeneous in older individuals, and non-cardiovascular (CV) mortality has increased. Previously, we defined a multi-marker modality that included cystatin C (CysC), troponin T (TnT), and age. Here, we validated this multi-marker risk score by evaluating its predictions of all-cause mortality and CV mortality in an independent population of older individuals with HF and reduced ejection fraction (HFrEF).
METHODS: This prospective cohort study : included 124 patients, median age 73 years, that had HFrEF. We determined all-cause mortality and CV mortality at a 3-year follow-up. We compared the risk score to the N-terminal prohormone of brain natriuretic peptide (NTproBNP) for predicting all-cause mortality and CV mortality.
RESULTS: High risk scores were associated with both all-cause mortality (HR: 4.2, 95%CI: 2.2-8.1; p<0.001) and CV mortality (HR: 3.6, 95%CI: 1.7-8.0; p=0.0015). Receiver operating characteristics showed similar efficacy for the risk score and NTproBNP in predicting all-cause mortality (0.74, 95%CI: 0.65-0.81 vs. 0.74, 95%CI: 0.65-0.81; p = 0.99) and CV mortality (0.68, 95%CI: 0.59-0.76 vs. 0.67, 95%CI: 0.58-0.75; p = 0.95). When the risk score was added to the NTproBNP, the continuous net reclassification improvement was 56% for predicting all-cause mortality (95%CI: 18-95%; p = 0.004) and 45% for predicting CV mortality (95%CI: 2-89%; p=0.040).
CONCLUSIONS: In HFrEF, a risk score that included age, TnT, and CysC showed efficacy similar to the NTproBNP for predicting all-cause mortality and CV mortality in an older population.