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Session: Heart
Session starts: Thursday 26 January, 10:30
Presentation starts: 11:15
Room: Room 558

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Jonna van der Stam ()
Sjoerd Bouwmeester ()
Saskia van Loon ()
Natal van Riel ()
Arjen-Kars Boer ()
Lukas Dekker ()
Patrick Houthuizen ()
Volkher Scharnhorst ()

Abstract:
Objective In clinical practice the classification of patients suffering from Heart Failure (HF) is done using the New York Heart Association (NYHA) Classification [1]. The NYHA is used by cardiologists to classify patients into four groups (NYHA I-IV) based on complaints during normal physical activity. However, this classification is subjective and has a significant inter-observer variability [2]. This research explores a HF -biomarker based classification for risk classification of HF patients. Methods HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off (NT-proBNP>1000pg/mL, ST2>35ng/mL, GDF-15>2000pg/mL and FGF-23>95.4pg/mL). Biomarkers that remained significant in multivariable analysis were combined into a Heartmarker score. The performance was compared to the New York Heart Association (NYHA) classification, which is widely used and accepted in clinical practice to classify HF patients. Results HF biomarkers of 245 patients were analyzed of whom 45 (18%) experienced the composite endpoint of HF hospitalization, appropriate ICD shock, or death. HF biomarkers were elevated more often in patients with the composite endpoint (NT-proBNP: 78% vs 31% p<0.01; GDF-15: 73% vs 34% p<0.01; ST-2: 31% vs 6% p<0.01; FGF-23: 42% vs 20% p=0.04). NT-proBNP, ST2, GDF-15 were independent predictors and were used to build the ‘Heartmarker’ score. Percentage of event-free survival and distance covered in 6-minutes of walking decreased with increasing ‘Heartmarker’ score (0: 97%, 1: 83%, 2-3: 56%; 0: 380m,1:340m,2-3:290m) Conclusion The Heartmarker score can be used as an intuitive model for risk stratification in HF outpatients. Compared to the NYHA classification, it was better at discriminating between different risk classes and had a comparable relation to functional capacity. It can be calculated automatically from results of biomarker measurements providing a reproducible and objective score for risk-classification of HF patients that could provide an additional tool for physicians.