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ESC Heart Fail. 2018 Jun;5(3):240-248. doi: 10.1002/ehf2.12268. Epub 2018 Feb 9.

Predicting new-onset HF in patients undergoing coronary or peripheral angiography: results from the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) study.

Author information

1
Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
2
Baim Institute for Clinical Research, Boston, MA, USA.
3
Department of Mathematics and Statistics, Boston University, Boston, MA, USA.
4
Cardiology Division, Radboud University Medical Center, Nijmegen, The Netherlands.
5
Cardiology Division, Maastricht University Medical Center, Maastricht, The Netherlands.
6
Cardiology Division, Brigham and Women's Hospital, Boston, MA, USA.
7
Cardiology Division, VA Connecticut Healthcare System and Yale University, New Haven, CT, USA.
8
Department of Biostatistics, Boston University, Boston, MA, USA.

Abstract

AIMS:

Methods to identify patients at risk for incident HF would be welcome as such patients might benefit from earlier interventions.

METHODS AND RESULTS:

From a registry of 1251 patients referred for coronary and/or peripheral angiography, we sought to identify independent predictors of incident HF during follow-up and develop a clinical and biomarker strategy to predict this outcome. There were 991 patients free of prevalent HF at baseline. Cox proportional hazard models were developed to predict adjudicated diagnosis of incident HF. Model discrimination and reclassification were evaluated. At follow-up, 177 (18%) developed new-onset HF. Independent predictors of new-onset HF included five clinical variables (age, male sex, heart rate, history of atrial fibrillation/flutter, and history of hypertension) and two biomarkers (amino-terminal pro-B type natriuretic peptide and ST2). The c-statistic for the model without biomarkers was 0.69; including biomarkers increased the c-statistic to 0.76 (P < 0.001). A score was developed from the model. Patients in the highest score quintile had shortest time to incident HF compared with lower quintiles (log-rank P < 0.001). Following 100 bootstrap iterations, internal validation was confirmed with Harrell's c-statistic of 0.77. Use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers at enrollment was associated with substantial attenuation of predictive value of the risk score.

CONCLUSIONS:

Patients undergoing coronary/peripheral angiographic procedures are a population at high risk for incident HF. We describe an accurate clinical and biomarker strategy for predicting incident HF and possibly intervening in such patients (NCT00842868).

KEYWORDS:

Biomarker; Diagnosis; HF; Score

PMID:
29424480
PMCID:
PMC5933950
DOI:
10.1002/ehf2.12268
[Indexed for MEDLINE]
Free PMC Article

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