Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

A novel risk score to predict outcome in advanced heart failure patients

A. Veshapeli1, P. Raake1, L. H. Lehmann1, M. Kreußer1, M. Volz1

1Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg;

Background: Risk stratification in patients with advanced heart failure is critical to facilitate timely referral to specialized centres and appropriate therapies. Several risk scores have shown a good predictive value in heart failure patients in general, however, established risk scores may be imprecise in advanced stages of the disease and further research in needed to improve clinical decisions in this vulnerable patient cohort. Methods: In this retrospective, single centre study we investigated the outcome of 883 patients with advanced heart failure undergoing thorough clinical assessment, including right heart catheterization and cardiac biomarkers. Primary endpoint was death, heart transplantation or left ventricular assist device implantation. Detailed patient characteristics including invasive hemodynamic and echocardiographic parameters as well as cardiac biomarkers at baseline were collected. Further, Seattle Heart Failure Model, the Meta-Analysis Global Group in Chronic Heart Failure Score and Interagency Registry for Mechanically Assisted Circulatory Support level were calculated for each patient. Univariate and multivariate cox hazard model was conducted to examine the impact of baseline variables on the primary endpoint. Further, a new risk model was calculated using invasive hemodynamic and cardiac biomarkers. Results: Of 883 included patients, 467 (53%) reached the primary endpoint with a mean follow-up time of 3.6 years (1323 days). Invasive hemodynamic parameters including cardiac Index, pulmonary artery pressure, right atrial pressure and mixed venous oxygen saturation as well as high sensitivity troponin T, N-terminal prohormone of brain natriuretic peptide and all included cardiac risk scores showed to be significant predictors of the primary endpoint in a cox proportional hazard model. We created a risk model using mixed venous oxygen saturation and high sensitivity troponin T allowing a more precise risk stratification in our patient cohort compared to established risk models. Conclusion: Invasive hemodynamics as well as established risk scores and cardiac biomarkers showed to be good predictors of survival in this advanced heart failure cohort. A newly created risk model using mixed venous oxygen saturation and high sensitivity troponin T can further improve risk stratification in this patient population.

https://dgk.org/kongress_programme/jt2022/aP1826.html