Cardiovascular and non‐cardiovascular death distinction: the utility of troponin beyond N‐terminal pro‐B‐type natriuretic peptide. Findings from the BIOSTAT‐CHF study

Ferreira, J. P. et al. (2020) Cardiovascular and non‐cardiovascular death distinction: the utility of troponin beyond N‐terminal pro‐B‐type natriuretic peptide. Findings from the BIOSTAT‐CHF study. European Journal of Heart Failure, 22(1), pp. 81-89. (doi: 10.1002/ejhf.1654) (PMID:31793144)

Abstract

Aims 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. Methods and results 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. Conclusions 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.

• Item Type: Articles
• Additional Information: This project was funded by a grant from the European Commission (FP7‐242209‐BIOSTAT‐CHF; EudraCT 2010–020808–29). J.P.F. and F.Z. are supported by the French National Research Agency Fighting Heart Failure (ANR‐15‐RHU‐0004), by the French PIA project ‘Lorraine Université d'Excellence’ GEENAGE (ANR‐15‐IDEX‐04‐LUE) programmes, and the Contrat de Plan Etat Région Lorraine and FEDER IT2MP.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Ferreira, J. P., Ouwerkerk, W., Tromp, J., Ng, L., Dickstein, K., Anker, S., Filippatos, G., Cleland, J. G., Metra, M., van Veldhuisen, D. J., Voors, A. A., and Zannad, F.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 02 December 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in European Journal of Heart Failure 22(1): 81-89
• Publisher Policy: Reproduced in accordance with the publisher copyright policy