title: Biomarkers and low risk in heart failure. Data from COACH and TRIUMPH.
abstract: OBJECTIVE
  Traditionally, risk stratification in heart failure (HF) emphasizes assessment of high risk. We aimed to determine if biomarkers could identify patients with HF at low risk for death or HF rehospitalization.
  
  
  RESULTS
  This analysis was a substudy of The Coordinating Study Evaluating Outcomes of Advising and Counselling in Heart Failure (COACH) trial. Enrolment of HF patients occurred before discharge. We defined low risk as the absence of death and/or HF rehospitalizations at 180 days. We tested a diverse group of 29 biomarkers on top of a clinical risk model, with and without N-terminal pro-B-type natriuretic peptide (NT-proBNP), and defined the low risk biomarker cut-off at the 10th percentile associated with high positive predictive value. The best performing biomarkers together with NT-proBNP and cardiac troponin I (cTnI) were re-evaluated in a validation cohort of 285 HF patients. Of 592 eligible COACH patients, the mean (± SD) age was 71 (± 11) years and median (IQR) NT-proBNP was 2521 (1301-5634) pg/mL. Logistic regression analysis showed that only galectin-3, fully adjusted, was significantly associated with the absence of events at 180 days (OR 8.1, 95% confidence interval 1.06-50.0, P = 0.039). Galectin-3, showed incremental value when added to the clinical risk model without NT-proBNP (increase in area under the curve from 0.712 to 0.745, P = 0.04). However, no biomarker showed significant improvement by net reclassification improvement on top of the clinical risk model, with or without NT-proBNP. We confirmed our results regarding galectin-3, NT-proBNP, and cTnI in the independent validation cohort.
  
  
  CONCLUSIONS
  We describe the value of various biomarkers to define low risk, and demonstrate that galectin-3 identifies HF patients at (very) low risk for 30-day and 180-day mortality and HF rehospitalizations after an episode of acute HF. Such patients might be safely discharged.
authors.affiliation: University of Groningen, University Medical Centre, Department of Cardiology, Hanzeplein 1, Groningen, the Netherlands.
authors.forename: Wouter C
authors.initials: WC
authors.lastname: Meijers
authors.affiliation: University of Groningen, University Medical Centre, Department of Cardiology, Hanzeplein 1, Groningen, the Netherlands.
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
authors.affiliation: University of Groningen, University Medical Centre, Department of Cardiology, Hanzeplein 1, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Faculty of health sciences, Linköping University, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: University of Groningen, University Medical Centre, Department of Cardiology, Hanzeplein 1, Groningen, the Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.affiliation: VA Medical Center, San Diego, CA, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
authors.affiliation: University of Rome La Sapienza, Department of Medical-Surgery and Translational Medicine, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.affiliation: University of Groningen, University Medical Centre, Department of Cardiology, Hanzeplein 1, Groningen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005260:Female; D037502:Galectin 3 / Q000032:analysis; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission; D010446:Peptide Fragments / Q000097:blood
chemical_list: D015415:Biomarkers; D037502:Galectin 3; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biomarker; Galectin-3; Heart failure; N-terminal pro-B-type natriuretic peptide; Prognosis; Risk stratification