A weighted risk score using bio-humoural, cardiopulmonary, and echocardiographic stress testing accurately predicted HF hospitalizations and cardiovascular death (AUC 0.92; 95% CI 0.88-0.96).
Cohort (n=304)
Does a multi-parametric risk score using biomarkers, CPET-ESE, and lung ultrasound predict adverse events in patients at risk for or with HFpEF?
A novel weighted risk score incorporating NT-proBNP, CPET, and stress echocardiography accurately stratifies risk for adverse events in patients across the spectrum of HFpEF development.
Effect estimate: AUC 0.92 (95% CI 0.88-0.96)
p-value: p=<0.01
AIMS: Risk stratification of heart failure (HF) patients with preserved ejection fraction (HFpEF) can promote a more personalized treatment. We tested the prognostic value of a multi-parametric evaluation, including biomarkers, cardiopulmonary exercise testing-exercise stress echocardiography (CPET-ESE), and lung ultrasound, in HFpEF patients and subjects at risk of developing HF (HF Stages A and B). BACKGROUND: Risk stratification of heart failure (HF) patients with preserved ejection fraction (HFpEF) can promote a more personalized treatment. DESIGN: We tested the prognostic value of a multi-parametric evaluation, including biomarkers, cardiopulmonary exercise testing-exercise stress echocardiography (CPET-ESE), and lung ultrasound, in HFpEF patients and subjects at risk of developing HF (HF Stages A and B). METHODS AND RESULTS: We performed a resting clinical/bio-humoural evaluation and a symptom-limited CPET-ESE in 274 patients (45 Stage A, 68 Stage B, and 161 Stage C-HFpEF) and 30 age- and sex-matched healthy controls. During a median follow-up of 18.5 months, we reported 71 HF hospitalizations and 10 cardiovascular deaths. Cox proportional-hazards regression identified five independent predictors and each was assigned a number of points proportional to its regression coefficient: stress-rest ΔB-lines >10 (3 points), peak oxygen consumption 900 pg/mL (1 point). The event-free survival probability for low risk (6 points) were 93%, 52%, and 20%, respectively. The area under the curve (AUC) for the scoring system to predict events was 0.92 (95% CI 0.88-0.96), with an accuracy significantly higher than the individual components of the score (all P < 0.01 vs. individual AUCs). CONCLUSION: A weighted risk score including NT-proBNP, markers of cardiopulmonary dysfunction and indices of exercise-induced pulmonary congestion identifies HFpEF patients at increased risk for adverse events and Stage A and B subjects more likely to progress towards more advanced HF stages.
Pugliese et al. (2020) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) and subjects at risk of developing HF (n=304). Weighted risk score (NT-proBNP, CPET-ESE, lung ultrasound) vs. Low risk score (<3 points) was evaluated on Heart failure hospitalizations and cardiovascular deaths (AUC 0.92, 95% CI 0.88-0.96, p=<0.01). A weighted risk score using bio-humoural, cardiopulmonary, and echocardiographic stress testing accurately predicted HF hospitalizations and cardiovascular death (AUC 0.92; 95% CI 0.88-0.96).