Biomarker‐driven prognostic models in chronic heart failure with preserved ejection fraction: the EMPEROR–Preserved trial

Pocock, S. J. et al. (2022) Biomarker‐driven prognostic models in chronic heart failure with preserved ejection fraction: the EMPEROR–Preserved trial. European Journal of Heart Failure, 24(10), pp. 1869-1878. (doi: 10.1002/ejhf.2607) (PMID:35796209)

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Background: Biomarker-driven prognostic models incorporating NT-proBNP and hs-cTnT in HFpEF are lacking. Aims: To generate a biomarker-driven prognostic tool for patients with chronic HFpEF enrolled in EMPEROR-Preserved. Methods: Multivariable Cox regression models were created for (i) the primary composite outcome of HF hospitalization or cardiovascular death (ii) all-cause death (iii) cardiovascular death and (iv) HF hospitalization. PARAGON-HF was used as a validation cohort. Results: NT-proBNP and hs-cTnT were the dominant predictors of the primary outcome, and in addition, a shorter time since last hospitalization, NYHA class III or IV, history of COPD, insulin-treated diabetes, low hemoglobin, and a longer time since HF diagnosis were key predictors (8 variables, all P<0.001). The consequent primary outcome risk score discriminated well (c-statistic=0.75) with patients in the top 10th of risk having an event rate >22x higher than those in the bottom 10th. A model for HF hospitalization alone had even better discrimination (c=0.79). Empagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure in patients across all risk levels. NT-proBNP and hs-cTnT were also the dominant predictors of all-cause and cardiovascular mortality followed by history of COPD, low albumin, older age, LVEF ≥50%, NYHA class III or IV and insulin-treated diabetes (8 variables, all P<0.001). The mortality risk model had similar discrimination for all-cause and cardiovascular mortality (c-statistic=0.72 for both). External validation provided c-statistics of 0.71, 0.71, 0.72, and 0.72 for the primary outcome, HF hospitalization alone, all-cause death, and cardiovascular death, respectively. Conclusions: The combination of NT-proBNP and hs-cTnT along with a few readily available clinical variables provides effective risk discrimination both for morbidity and mortality in patients with HFpEF. A predictive toolkit facilitates the ready implementation of these risk models in routine clinical practice.

Item Type:Articles
Additional Information:The EMPEROR-Reduced trial was supported by Boehringer Ingelheim and Eli Lilly and Company. Dr. Januzzi is supported in part by the Hutter Family Professorship at Harvard Medical School.
Glasgow Author(s) Enlighten ID:Kondo, Dr Toru and Ferreira, Mr Joao Pedro and McMurray, Professor John
Authors: Pocock, S. J., Ferreira, J. P., Packer, M., Zannad, F., Filippatos, G., Kondo, T., McMurray, J. J.V., Solomon, S. D., Januzzi, J. L., Iwata, T., Salsali, A., Butler, J., and Anker, S. D.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:07 July 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in European Journal of Heart Failure 24(10): 1869-1878
Publisher Policy:Reproduced under a Creative Commons License

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