Risk Stratification of Patients With Severe Heart Failure Awaiting Heart Transplantation—Prospective National Registry POLKARD HF

Risk Stratification of Patients With Severe Heart Failure Awaiting Heart Transplantation—Prospective National Registry POLKARD HF

Abstract Most methods used in the risk assessment of heart transplant candidates do not include new biomarkers. Aims The aim of the study was to examine the value of NTproBNP and hsCRP and their combined use together with HFSS score in the risk assessment of patients with heart failure enlisted for...

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Bibliographic Details
Published in:Transplantation proceedings Vol. 41; no. 8; pp. 3161 - 3165
Main Authors: Zieliński, T, Browarek, A, Zembala, M, Sadowski, J, Zakliczyński, M, Przybylowski, P, Roguski, K, Kosakowska, A.B, Korewicki, J
Format: Journal Article Conference Proceeding
Language:English
Published: Amsterdam Elsevier Inc 01-10-2009
Elsevier
Subjects:
Biological and medical sciences
C-Reactive Protein - metabolism
Cardiology. Vascular system
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Heart
Heart Failure - physiopathology
Heart Failure - surgery
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Heart Transplantation - mortality
Heart Transplantation - physiology
Humans
Medical sciences
Multicenter Studies as Topic
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Poland
Predictive Value of Tests
Probability
Registries
Risk Assessment
Risk Factors
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survival Analysis
Survivors
Tissue, organ and graft immunology
Waiting Lists
Poland
Heart
Human
Heart failure
Cardiovascular disease
Patient
Risk
Transplantation
Homotransplantation
Medicine
Prospective
Treatment
Heart disease
Surgery
Specific registry
Risk factor
Graft
Circulatory system
Waiting list
Severe
Stratification
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Summary:Abstract Most methods used in the risk assessment of heart transplant candidates do not include new biomarkers. Aims The aim of the study was to examine the value of NTproBNP and hsCRP and their combined use together with HFSS score in the risk assessment of patients with heart failure enlisted for heart transplantation. Methods Data of 658 patients enlisted for heart transplantation in all active transplantation centers were stored in a prospective registry. The composite end point-death or urgent transplantation was recorded during the follow-up. Results Death or urgent transplantation was recorded in 161 (24%) of pts. 102 (15%) patients died and 59 (9%) were transplanted urgently. Kaplan-Meier curves for risk of death or urgent transplantation where highly significant when pts were stratified by the quartiles of NT proBNP ( P < .000001) or quartiles according to the hsCRP level on admission ( P < .002). In the multivariate Cox proportional hazard model, the significance was observed for NTproBNP ( P < .01) and HFSS ( P < .02), and borderline significance for hsCRP ( P = .057). When ROC analyses of the area under the curve (AUC) values were considered, AUC area was for HFSS – 0.645, for NTproBNP – 0.653 and for hsCRP – 0.566. When all those variables were included together in the model, the AUC value rose to 0.6943. Based on those results a weighted risk model with all three parameters was proposed. Conclusion HFSS, NTproBNP and hsCRP levels are independent stratification variables of survival or need for urgent heart transplantation. Their predictive value is moderately increased when they are analyzed together.
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ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2009.09.049