N-terminal fraction of pro-B-type natriuretic peptide versus clinical risk scores for prognostic stratification in chronic systolic heart failure

Abstract

Background The Seattle heart failure model or the cardiac and comorbid conditions (3C-HF) scores may help define patient risk in heart failure. Direct comparisons between them or versus N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) have never been performed. Methods Data from consecutive patients with stable systolic heart failure and 3C-HF data were examined. A subgroup of patients had the Seattle heart failure model data available. The endpoints were one year all-cause or cardiovascular death. Results The population included 2023 patients, aged 68 ± 12 years, 75% were men. At the one year time-point, 198 deaths were recorded (10%), 124 of them (63%) from cardiovascular causes. While areas under the curve were not significantly different, NT-proBNP displayed better reclassification capability than the 3C-HF score for the prediction of one year all-cause and cardiovascular death. Adding NT-proBNP to the 3C-HF score resulted in a significant improvement in risk prediction. Among patients with Seattle heart failure model data available ( n = 798), the area under the curve values for all-cause and cardiovascular death were similar for the Seattle heart failure model score (0.790 and 0.820), NT-proBNP (0.783 and 0.803), and the 3C-HF score (0.770 and 0.800). The combination of the 3C-HF score and NT-proBNP displayed a similar prognostic performance to the Seattle heart failure model score for both endpoints. Adding NT-proBNP to the Seattle heart failure model score performed better than the Seattle heart failure model alone in terms of reclassification, but not discrimination. Conclusions Among systolic heart failure patients, NT-proBNP levels had better reclassification capability for all-cause and cardiovascular death than the 3C-HF score. The inclusion of NT-proBNP to the 3C-HF and Seattle heart failure model score resulted in significantly better risk stratification.

When more is less and less is more: Is there an additional value of NT-proBNP in risk stratification in heart failure?

“…This score assessed the incremental predictive value of NT-proBNP for 1-year all-cause mortality compared with a score containing six clinical variables. 26 Similar to the study reported by Arzilli et al, 16 the inclusion of NT-proBNP did not improve discrimination, but resulted in a significant improvement in reclassification for 1-year mortality risk. 26 Likewise, data from seven prospective studies were used to develop the ELAN-HF score for the prediction of 6-month allcause mortality risk in acute HF.…”

“…In conclusion, available evidence supports the utility of BNP and NT-proBNP in risk stratification of HF patients. The present study by Arzilli et al 16 provides further insight into the role of biomarkers by demonstrating an additive value of NT-proBNP to the conventional risk scores. From the clinical perspective, improvement in the ability to 'flag' apparently stable chronic HF patients at high risk could benefit those patients.…”

“…[12][13][14] Likewise, changes in natriuretic peptide levels over time convey incremental prognostic value with respect to HF outcomes. 15 In the study published in the current issue of the European Journal of Preventive Cardiology, Arzilli et al 16 have further advanced the concept of biomarker measurement in HF. They have assessed whether the addition of NT-proBNP to the two established risk scores improves stratification of the risk for all-cause and cardiovascular mortality in chronic HF patients.…”

The MECKI score initiative: Development and state of the art

“…new drugs, CRT/ICD implant, biomarkers, risk factor control, coronary and valvular interventions) have clearly modified the prognosis of heart failure patients also in advanced stages of the disease. 41,44,45 In conclusion, the MECKI score initiative has proven to be a simple, useful tool for risk stratification and for Figure 1. Receiver operating characteristic analysis of the MECKI score.…”

Comparison of MAGGIC and MECKI risk scores to predict mortality after cardiac rehabilitation among Dutch heart failure patients

“…4 Risk prediction among cardiovascular patients is an emerging topic of interest. [5][6][7] To gain insight into the prognosis of heart failure, several clinical risk models were developed, such as the Meta-Analysis Global Group in Chronic heart failure (MAGGIC) and Metabolic Exercise data combined with Cardiac and Kidney Indexes (MECKI) score. 8,9 Both MAGGIC and MECKI scores are internally and externally validated, [8][9][10][11] but their clinical use is limited to specific settings.…”