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A Novel Risk Score Combining Biomarkers of Hypervolemia Predicts 1-Year Outcomes in Heart Failure Patients with Preserved Ejection Fraction
Session:
SESSÃO DE POSTERS 21 - IC E PROGNÓSTICO
Speaker:
Tiago Filipe Aguiar
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Tiago Filipe Aguiar
Abstract
<p><strong>Introduction:</strong></p> <p>Heart failure (HF) with preserved ejection fraction (HFpEF) encompasses a wide range of phenotypes with different prognostic implications. There is a need for biomarkers and score systems that can identify which patients are at highest risk and require closer follow up and more intensive treatment.</p> <p><strong>Purpose:</strong></p> <p>To evaluate the independent prognostic value of biomarkers indictive of hypervolemic status, and to create a novel risk score to predict future events.</p> <p><strong>Methods:</strong></p> <p>We performed a cohort analysis of HFpEF patients admitted to the cardiology ward due to acute/chronic decompensated HF. We selected the following variables to assess the volemic status: 1) high estimated plasma volume status (ePVS), calculated from hematocrit and hemoglobin values, with a cut-off of ≥ 5 ml/g ; 2) hyponatremia, with a cut off of ≤134 mmol; 3) high NTpro-BNP levels, with a cut-off of ≥1000 pg/mL; 4) high blood urea to creatinine (BUN/Creat) ratio with high serum creatinine levels, with a combined cut-off of creatinine ≥1.5 mg/dL and BUN/Creat ≥ 30 mg/dL. A composite endpoint CE of cardiovascular mortality and hospital admissions at 1 year was utilized. With these variables, a novel score system was created and tested against the CE with Kaplan-Meier survival curve and multivariate Cox Regression analyis.</p> <p><strong>Results:</strong></p> <p>Our cohort included 159 patients with HFpEF with at least one hospital admittance due to HF, of which 60% were male, with a mean age of 77 years old. There was a high frequency of cardiovascular risk factors (CVRF) and co-morbidities (Table 1). In our analysis, ePVS had the strongest association with the CE (log-rank 4.25, P=0.39); HypoNa and BUN/Creat were also positively associated with the CE (log-rank 3.67, P=0.05 and 3.86, P=0.05, respectively). NTpro-BNP was strongly associated with cardiovascular death alone, but not with the CE. A novel score system was created, where high ePVS, hyponatremia and high BUN/Creat were each awarded 1 point. There was a strong association between this score and the CE (log-rank 10.95, P=0.01), confirmed in a multivariate adjustment for cardiovascular risk factors and comorbidities (hazard ratio 1.35, P=0.01) (Figure 1). Interestingly, this score was also strongly associated with cardiovascular mortality alone (log-rank 10.91, P=0.01).</p> <p><strong>Conclusion:</strong></p> <p>The biomarkers of hypervolemia and the novel scoring system were independent predictors of future cardiac events, and could serve as an effective tool to identify high-risk patients in this population.</p>
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