Development of a Novel Heart Failure Risk Tool: The Barcelona Bio-Heart Failure Risk Calculator (BCN Bio-HF Calculator)

Abstract

BackgroundA 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.MethodsModel 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.ResultsThe 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.ConclusionsA new HF risk-calculator that incorporates available biomarkers reflecting different pathophysiological pathways better allowed individual prediction of death at 1, 2, and 3 years.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…W ostatnich dekadach opracowano wiele różnych skal ryzyka dla różnych populacji pacjentów z HF [36][37][38][39][40][41], które są częściowo dostępne w formie interaktywnych aplikacji online. Skale ryzyka oparte na wielu zmiennych mogą być pomocne w przewidywaniu ryzyka zgonu, ale mają mniejsze znaczenie dla oceny ryzyka ponownej hospitalizacji pacjenta z HF [37,38].…”

Dual chronoamperometric detection of enzymatic biomarkers using magnetic beads and a low-cost flow cell

“…Working under flow conditions allowed us to compare the efficiency of two different detection strategies: measurement of steady state currents and generation of stop-flow peaks (in which flow retention for a fixed time results in building up of the enzymatic product, improving detection significantly). The results obtained show that the microfluidic platform described here is capable of multiplexed biomarker determination, which is crucial for diagnosis and stratification of heart diseases (Lupón et al, 2014).…”

Personalized Treatment of Heart Failure with Biomarker Guidance Using a Novel Disease Severity Score

“…Th e Barcelona Bio-Heart Failure Risk Calculator incorporating ST2, N-terminal pro BNP, and troponin T biomarkers allowed better prediction of death among HF patients (7). Compared to the Seattle Heart Failure Model, the Penn Heart Failure Study found that a multimarker score incorporating biomarkers increased the ability to predict adverse outcomes in ambulatory patients with chronic HF (8).…”