Francesco Massari1, Pietro Scicchitano2, Massimo Iacoviello3, Andrea Passantino4, Piero Guida4, Mariella Sanasi3, Assunta Piscopo3, Roberta Romito5, Roberto Valle6, Pasquale Caldarola7, Marco Matteo Ciccone3. 1. Cardiology Section, F. Perinei Hospital, Altamura, Bari, Italy. 2. Cardiology Section, F. Perinei Hospital, Altamura, Bari, Italy; Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. Electronic address: piero.sc@hotmail.it. 3. Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. 4. Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, Cassano delle Murge, Bari, Italy. 5. Emergency Cardiology Unit, Policlinic University Hospital, Bari, Italy. 6. Cardiology Department, Hospital of Chioggia, Chioggia, Venezia, Italy. 7. Cardiology Section, S. Paolo Hospital, Bari, Italy.
Abstract
BACKGROUND: Congestion is a marker of adverse prognosis in patients with heart failure (HF). In addition to brain natriuretic peptide (BNP), estimated plasma volume status (ePVS), bioimpedance vector analysis (BIVA), and blood urea nitrogen/creatinine ratio (BUN/Cr) are emerging as new markers for congestion. The aim of this study was to evaluate the prognostic value of BNP, ePVS, BIVA, and BUN/Cr in HF. METHODS: We analyzed the data from 436 patients with acute or chronic heart failure (AHF, n=184, and CHF, n=252, respectively). BNP, ePVS, hydration index (HI%), and BUN/Cr were collected from all patients at admission. The endpoint was all-cause mortality. RESULTS: Ninety-two patients died after a median follow-up of 463 days (IQR: 287-669). The cumulative mortality of all of the patients was 21% (31% and 13% in AHF and CHF, respectively, p<0.0001). The optimal cut-offs for death occurrence were BNP: >441pg/mL, ePVS: >5.3dL/gr, HI: >73.8%, BUN/Cr: >25. Multivariate Cox regression analysis maintained an independent predictive value for mortality (HR 2. 1, HR 2.2, HR 2.1, and HR 1.7; C-index 0.756). AHF status was no longer associated with death. Together, these variables explained 40% of the risk of death (R2 adjusted=0.40). Patients with all four parameters below or above their optimal cut-off had mortality rates of 4% and 59%, respectively. CONCLUSIONS: BNP, ePVS, BIVA, and BUN/Cr at admission provide independent and complementary prognostic information in patients with HF and, when combined, explain the 40% risk of death in these patients independent from the acute or chronic HF condition.
BACKGROUND: Congestion is a marker of adverse prognosis in patients with heart failure (HF). In addition to brain natriuretic peptide (BNP), estimated plasma volume status (ePVS), bioimpedance vector analysis (BIVA), and blood ureanitrogen/creatinine ratio (BUN/Cr) are emerging as new markers for congestion. The aim of this study was to evaluate the prognostic value of BNP, ePVS, BIVA, and BUN/Cr in HF. METHODS: We analyzed the data from 436 patients with acute or chronic heart failure (AHF, n=184, and CHF, n=252, respectively). BNP, ePVS, hydration index (HI%), and BUN/Cr were collected from all patients at admission. The endpoint was all-cause mortality. RESULTS: Ninety-two patients died after a median follow-up of 463 days (IQR: 287-669). The cumulative mortality of all of the patients was 21% (31% and 13% in AHF and CHF, respectively, p<0.0001). The optimal cut-offs for death occurrence were BNP: >441pg/mL, ePVS: >5.3dL/gr, HI: >73.8%, BUN/Cr: >25. Multivariate Cox regression analysis maintained an independent predictive value for mortality (HR 2. 1, HR 2.2, HR 2.1, and HR 1.7; C-index 0.756). AHF status was no longer associated with death. Together, these variables explained 40% of the risk of death (R2 adjusted=0.40). Patients with all four parameters below or above their optimal cut-off had mortality rates of 4% and 59%, respectively. CONCLUSIONS:BNP, ePVS, BIVA, and BUN/Cr at admission provide independent and complementary prognostic information in patients with HF and, when combined, explain the 40% risk of death in these patients independent from the acute or chronic HF condition.
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Authors: Pietro Scicchitano; Claudio Paolillo; Micaela De Palo; Angela Potenza; Silvia Abruzzese; Marco Basile; Antonia Cannito; Maria Tangorra; Piero Guida; Pasquale Caldarola; Marco Matteo Ciccone; Francesco Massari Journal: J Cardiovasc Dev Dis Date: 2022-02-24