Development of a novel heart failure risk tool: the barcelona bio-heart failure risk calculator (BCN bio-HF calculator).
BACKGROUND
A combination of clinical and routine laboratory data with biomarkers reflecting different pathophysiological pathways may help to refine risk stratification in heart failure (HF). A novel calculator (BCN Bio-HF calculator) incorporating N-terminal pro B-type natriuretic peptide (NT-proBNP, a marker of myocardial stretch), high-sensitivity cardiac troponin T (hs-cTnT, a marker of myocyte injury), and high-sensitivity soluble ST2 (ST2), (reflective of myocardial fibrosis and remodeling) was developed.


METHODS
Model performance was evaluated using discrimination, calibration, and reclassification tools for 1-, 2-, and 3-year mortality. Ten-fold cross-validation with 1000 bootstrapping was used.


RESULTS
The BCN Bio-HF calculator was derived from 864 consecutive outpatients (72% men) with mean age 68.2 ± 12 years (73%/27% New York Heart Association (NYHA) class I-II/III-IV, LVEF 36%, ischemic etiology 52.2%) and followed for a median of 3.4 years (305 deaths). After an initial evaluation of 23 variables, eight independent models were developed. The variables included in these models were age, sex, NYHA functional class, left ventricular ejection fraction, serum sodium, estimated glomerular filtration rate, hemoglobin, loop diuretic dose, β-blocker, Angiotensin converting enzyme inhibitor/Angiotensin-2 receptor blocker and statin treatments, and hs-cTnT, ST2, and NT-proBNP levels. The calculator may run with the availability of none, one, two, or the three biomarkers. The calculated risk of death was significantly changed by additive biomarker data. The average C-statistic in cross-validation analysis was 0.79.


CONCLUSIONS
A new HF risk-calculator that incorporates available biomarkers reflecting different pathophysiological pathways better allowed individual prediction of death at 1, 2, and 3 years.
Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Josep
J
Lupón
Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Marta
M
de Antonio
IMIM (Hospital del Mar Medical Research Institute), Barcelona. Spain ; CIBER Epidemiology and Public Health, Barcelona, Spain.
Joan
J
Vila
IMIM (Hospital del Mar Medical Research Institute), Barcelona. Spain ; CIBER Epidemiology and Public Health, Barcelona, Spain.
Judith
J
Peñafiel
Biochemistry Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Amparo
A
Galán
Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Elisabet
E
Zamora
Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Agustín
A
Urrutia
Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Antoni
A
Bayes-Genis
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment