Page 150 - Biomarkers for risk stratification and guidance in heart failure

Heart failure (HF) is a complex syndrome characterized by high morbidity, mortality and disease associated health care costs.1,2 In order to adequately treat HF it is important not only to diagnose HF at is earliest stage, but also to detect worsening heart failure once cardiac status deteriorates. Dyspnea is the main complaint in HF, however dyspnea can be caused by a wide variety of diseases where some are harmless while others are deadly. Last decades, several biomarkers have been proposed for risk stratification and treatment guidance in heart failure with natriuretic peptides being the most investigated.
This thesis aims to (i) assess the additive value of multiple biomarkers for risk assessment in patients presenting to the emergency department with dyspnea as main complaint and (ii) assess the value of natriuretic peptides in the treatment of chronic heart failure.
7.1 RISK ASSESSMENT IN EMERGENCY DEPARTMENT DYSPNEA: MARKED-RISK SCORE IN PERSPECTIVE
In chapter 2 we investigated 5 biomarkers (N-terminal pro-B-type natriuretic
peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), high-
sensitivity C-reactive protein (hs-CRP), galectin-3 (Gal-3) and cystatin-C (Cys-C))
with a distinct pathophysiological background for short-term risk stratification
in 603 patients with dyspnea presenting to the emergency department (ED).
Combining these biomarkers with other clinical risk factors we found that hs-
CRP, hs-cTnT and Cys-C were of independent prognostic importance. These independent risk factors led to development of the multi marker emergency 7 dyspnea-risk score (MARKED-risk score) incorporating risk factors age ≥75 years,
systolic blood pressure < 110 mmHg, history of heart failure, dyspnea NYHA fc IV, hs-cTnT ≥ 0.04 μg/l, hs-CRP ≥ 25 mg/l and Cys-C ≥ 1.125 mg/l. This score predicted 90-day mortality excellently with an area under the curve (AUC) of 0.85 (95% confidence interval (CI) 0.81 to 0.89) and identified patients at low (2%), intermediate (14%) and high (44%) risk of 90-day mortality. The predictive accuracy of our model is much higher compared those of currently used risk scores in other fields like CHA2DS2-Vasc3 (AUC 0.61) or HAS-BLED4 (AUC 0.72).
In the majority of patients presenting to the cardiac emergency department (ED) with HF, dyspnea is the main complaint5. Dyspnea can be caused by a wide variety of diseases although HF has reported to be the most frequent cause of
General Discussion
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