Development of a novel heart failure risk tool: the barcelona bio-heart failure risk calculator (BCN bio-HF calculator)

PLoS One. 2014 Jan 15;9(1):e85466. doi: 10.1371/journal.pone.0085466. eCollection 2014.

Abstract

Background: A combination of clinical and routine laboratory data with biomarkers reflecting different pathophysiological pathways may help to refine risk stratification in heart failure (HF). A novel calculator (BCN Bio-HF calculator) incorporating N-terminal pro B-type natriuretic peptide (NT-proBNP, a marker of myocardial stretch), high-sensitivity cardiac troponin T (hs-cTnT, a marker of myocyte injury), and high-sensitivity soluble ST2 (ST2), (reflective of myocardial fibrosis and remodeling) was developed.

Methods: Model performance was evaluated using discrimination, calibration, and reclassification tools for 1-, 2-, and 3-year mortality. Ten-fold cross-validation with 1000 bootstrapping was used.

Results: The BCN Bio-HF calculator was derived from 864 consecutive outpatients (72% men) with mean age 68.2 ± 12 years (73%/27% New York Heart Association (NYHA) class I-II/III-IV, LVEF 36%, ischemic etiology 52.2%) and followed for a median of 3.4 years (305 deaths). After an initial evaluation of 23 variables, eight independent models were developed. The variables included in these models were age, sex, NYHA functional class, left ventricular ejection fraction, serum sodium, estimated glomerular filtration rate, hemoglobin, loop diuretic dose, β-blocker, Angiotensin converting enzyme inhibitor/Angiotensin-2 receptor blocker and statin treatments, and hs-cTnT, ST2, and NT-proBNP levels. The calculator may run with the availability of none, one, two, or the three biomarkers. The calculated risk of death was significantly changed by additive biomarker data. The average C-statistic in cross-validation analysis was 0.79.

Conclusions: A new HF risk-calculator that incorporates available biomarkers reflecting different pathophysiological pathways better allowed individual prediction of death at 1, 2, and 3 years.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Heart Failure / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Risk Assessment

Grant support

ST2 assays were performed by Critical Diagnostics; hs-cTnT and NT-proBNP assays were provided by Roche Diagnostics, which also provided a grant for statistical development and online application of the calculator. Dr. M. de Antonio received a competitive research grant from the Catalan Society of Cardiology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.