title: Prognosis of new-onset heart failure outpatients and collagen biomarkers.
abstract: BACKGROUND
  Prognosis of heart failure patients has been defined in hospital-based or retrospective studies. This study aimed to characterize prognosis of outpatients with new-onset preserved or reduced ejection fraction heart failure; to explore the role of collagen turnover biomarkers (MMP2, MMP9, TIMP1) in predicting prognosis; and to analyse their relationship with echocardiographic parameters and final diagnosis.
  
  
  METHODS
  This is an observational, prospective, longitudinal study. Outpatients with new-onset heart failure symptoms referred to a one-stop clinic were included. Echocardiography and biomarkers plasma levels determination were performed at the inclusion. A prospective follow-up was conducted to report cardiovascular events. The discriminant analysis was applied to identify the parameters related to cardiovascular outcomes.
  
  
  RESULTS
  A total of 172 patients (75 ± 9 years) were included, 67% with heart failure (64% preserved and 36% with reduced ejection fraction). During follow-up (median 34.5 months), 32.6% had at least one cardiovascular event and 9.9% died. Heart failure groups showed no differences in cardiovascular outcomes with a higher rate of events than nonheart failure patients. MMP2 and TIMP1 were correlated with diastolic dysfunction (Rho 0.349 and 0.294, P < 0.001). In the discriminant analysis, the combination of biomarkers with clinical, biochemical and echocardiographic parameters was useful to predict cardiovascular outcomes (AUC ROC 0.806, Wilks lambda 0.7688, P < 0.001).
  
  
  CONCLUSIONS
  Prognosis of outpatients with new-onset heart failure symptoms is comparable between heart failure with preserved or reduced subgroups. The addition of biomarkers specially MMP2 and high sensitive troponin I to other clinical, biochemical and echocardiographic variables can predict cardiovascular prognosis at the time of diagnosis.
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Sanchis
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Rut
authors.initials: R
authors.lastname: Andrea
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Falces
authors.affiliation: Department of Statistics, University of Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Llopis
authors.affiliation: Biochemistry and Molecular Genetics Department, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morales-Ruiz
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: López-Sobrino
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Pérez-Villa
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D003094:Collagen / Q000378:metabolism*; D016002:Discriminant Analysis; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood*; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood*; D019210:Troponin I / Q000097:blood; D018754:Ventricular Dysfunction / Q000097:blood* / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers; C560822:TIMP1 protein, human; D019715:Tissue Inhibitor of Metalloproteinase-1; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D003094:Collagen; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9
keywords: collagent turnover biomarkers; discriminant analysis; heart failure; heart failure with preserved left ventricular ejection fraction; outpantients; prognosis