McDowell, K. et al. (2023) Incremental prognostic value of biomarkers in PARADIGM-HF. European Journal of Heart Failure, 28(8), 1406-1414-1406-1414. (doi: 10.1002/ejhf.2887) (PMID:37191207)
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Abstract
Background: It is uncertain how much candidate biomarkers improve risk prediction when added to comprehensive models including routinely collected clinical and laboratory variables in heart failure. Methods: Aldosterone, cystatin C, high sensitivity-troponin T (hs-TnT), galectin-3, growth differentiation factor-15 (GDF-15), kidney injury molecule-1 (KIM-1), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), soluble suppression of tumorigenicity-2 (ST2), tissue inhibitor of metalloproteinase-1 (TIMP-1) and urinary albumin to creatinine ratio (UACR) were measured in 1559 of PARADIGM-HF participants.We tested whether these biomarkers, individually or collectively, improved the performance of the PREDICT-HF prognostic model, which includes clinical, routine laboratory, and natriuretic peptide data, for the primary endpoint and cardiovascular and all-cause mortality. Results: The mean age of participants was 67.3 ± 9.9 years, 1254 (80.4%) were men and 1103 (71%) were NYHA class II. During a mean follow-up of 30.7 months, 300 patients experienced the primary outcome and 197 died. Added individually, only 4 biomarkers were independently associated with all outcomes: hs-TnT, GDF-15, cystatin C and TIMP-1. When all biomarkers were added simultaneously to the PREDICT-HF models, only hs-TnT remained an independent predictor of all three endpoints. GDF-15 also remained predictive of the primary endpoint; TIMP-1 was the only other predictor of both cardiovascular and all-cause mortality. Individually or in combination, these biomarkers did not lead to statistically significant improvements in discrimination or reclassification. Conclusions: None of the biomarkers studied individually or collectively led to a meaningful improvement in the prediction of outcomes over what is provided by clinical, routine laboratory, and natriuretic peptide variables.
| Item Type: | Articles |
|---|---|
| Additional Information: | The PARADIGM-HF study was funded by Novartis. JJVM is supported by a British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Simpson, Dr Joanne and McDowell, Dr Kirsty and Jhund, Professor Pardeep and Campbell, Dr Ross and McMurray, Professor John |
| Authors: | McDowell, K., Campbell, R., Simpson, J., Cunningham, J. W., Desai, A. S., Jhund, P. S., Lefkowitz, M. P., Rouleau, J. L., Swedberg, K., Zile, M. R., Solomon, S. D., Packer, M., and McMurray, J. J.V. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | European Journal of Heart Failure |
| Publisher: | Wiley |
| ISSN: | 1388-9842 |
| ISSN (Online): | 1879-0844 |
| Published Online: | 16 May 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in European Journal of Heart Failure 25(8):1406-1414 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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