The Heartmarker score (NT-proBNP, ST2, GDF-15) better discriminated risk classes for HF hospitalization, ICD shock, or death (18% event rate) compared with the NYHA classification.
Observational (n=245)
Does the Heartmarker score improve risk stratification compared to NYHA classification in heart failure outpatients?
The Heartmarker score, combining NT-proBNP, ST2, and GDF-15, provides a reproducible and intuitive model for risk stratification of HF outpatients that discriminates risk classes better than NYHA classification.
Background: Heart failure (HF) biomarkers have prognostic value. The aim of this study was to combine HF biomarkers into an objective classification system for risk stratification of patients with HF. Methods: HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off values (N-terminal pro-B-type natriuretic peptide NT-proBNP >1,000 pg/mL, soluble suppression of tumorigenesis-2 ST2 >35 ng/mL, growth differentiation factor-15 GDF-15 >2,000 pg/mL, and fibroblast growth factor-23 FGF-23 >95.4 pg/mL). Biomarkers that remained significant in multivariable analysis were combined to devise the Heartmarker score. The performance of the Heartmarker score was compared to the widely used New York Heart Association (NYHA) classification based on symptoms during ordinary activity. Results: HF biomarkers of 245 patients were analyzed, 45 (18%) of whom experienced the composite endpoint of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. HF biomarkers were elevated more often in patients that reached the composite endpoint than in patients that did not reach the endpoint. NT-proBNP, ST2, and GDF-15 were independent predictors of the composite endpoint and were thus combined as the Heartmarker score. The event-free survival and distance covered in 6 minutes of walking decreased with an increasing Heartmarker score. Compared with the NYHA classification, the Heartmarker score was better at discriminating between different risk classes and had a comparable relationship to functional capacity. Conclusions: The Heartmarker score is a reproducible and intuitive model for risk stratification of outpatients with HF, using routine biomarker measurements.
Stam et al. (Thu,) conducted a observational in Heart failure (n=245). Heartmarker score vs. NYHA classification was evaluated on Composite of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. The Heartmarker score (NT-proBNP, ST2, GDF-15) better discriminated risk classes for HF hospitalization, ICD shock, or death (18% event rate) compared with the NYHA classification.