Open AccessPrediction of Long‐Term Survival in Chronic Heart Failure by Multiple Biomarker Assessment: A 15‐Year Prospective Follow‐Up Study
Author(s) -
Volpe Massimo,
Francia Pietro,
Tocci Giuliano,
Rubattu Speranza,
Cangianiello Sara,
Elena Rao Maria Assunta,
Trimarco Bruno,
Condorelli Mario
Publication year - 2010
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20813
Subject(s) - medicine , hazard ratio , context (archaeology) , heart failure , confidence interval , biomarker , prospective cohort study , cardiology , proportional hazards model , erythropoietin , paleontology , biochemistry , chemistry , biology
Background: In chronic heart failure (CHF), several plasma biomarkers identify subjects at risk of death over the midterm. However, their long‐term predictive value in the context of other candidate predictors has never been assessed. This information may prove valuable in the management of a chronic disease with a long natural history, as CHF is today. Hypothesis: We aimed to assess the very‐long‐term prognostic power of a set of biomarkers to identify CHF patients at highest risk for all‐cause mortality. Methods: A group of 106 consecutive outpatients with CHF (85 male and 21 female, median age 56 y) was followed for 15 years. Echocardiographic tracings and blood samples were collected at study entry to evaluate cardiac function, plasma atrial natriuretic peptide (ANP), aldosterone, and erythropoietin, and plasma renin activity. The relationships between biomarkers, clinical and echocardiographic variables, and mortality were assessed. Results: After 15 years, 86 of the 106 patients (81%) had died. Multivariate analysis showed that ANP was the best independent predictor of survival over several clinical, echocardiographic, and humoral variables (hazard ratio: 5.62, 95% confidence interval: 3.37–9.39, P < 0.001 for plasma levels < median value of 71 pg/mL). Plasma renin activity and erythropoietin provided prognostic information in univariate analysis, but lost their predictive power when adjusted for covariates. Conclusions: The present study represents the longest available follow‐up of patients with CHF evaluating the prognostic power of multiple biomarkers. It shows that a simple assessment of plasma ANP levels is the strongest long‐term predictor of death in all stages of heart failure. Copyright © 2010 Wiley Periodicals, Inc. This work was supported by a grant from MIUR 2001068248. The authors have no other funding, financial relationships, or conflicts of interest to disclose.