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INTRODUCTION: A combination of biochemical and clinical variables with new biomarkers is evaluated for the potential to improve the management of patients with heart failure (HF). OBJECTIVES: This study assessed the predictive utility of a new prognostic scale, the Barcelona Bio-Heart Failure Risk Score (BCN), as well as traditional scores, the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM), in patients with end-stage HF. We also investigated the other risk factors associated with worse prognosis in the analyzed population. PATIENTS AND METHODS: We performed a prospective analysis of 279 patients with end-stage HF listed for heart transplantation between 2018 and 2021. Their BCN, HFSS and SHFM were calculated. Human suppression of tumorigenicity 2 (ST2) was measured with a commercially available kit (Human ST-2 ELISA, SunRedBio Technology Co., Ltd., Shanghai, China). RESULTS: The median age of the patients was 56.0 (50.0-60.0) years, and 87.1% were male. During the one-year follow-up, 95 (34.1%) patients died. The areas under ROC associated with one-year mortality were as follows: 0.9466 [95% CI: 0.9194-0.9737] for BCN, 0.8092 [0.7606-0.8578] for HFSS, and 0.6967 [0.6349-0.7585] for SHFM. BCN (HR = 0.985 [0.981-0.988], P <0.001), HFSS (HR = 0.357 [0.236-0.541], P <0.001] and circulating bilirubin concentration (HR = 1.015 [1.002-1.028], P = 0.02) were associated with one-year mortality in the analyzed population. CONCLUSIONS: The BCN risk score had significantly better prognostic performance than HFSS or SHFM. Lower BCN and HFSS scores and higher bilirubin are independently associated with a higher risk of one-year death in patients with end-stage HF.
RESUMO
The role of oxidative/antioxidative system imbalances in advanced heart failure (HF) has not been fully investigated. The aim of this study was to identify factors associated with one-year mortality in patients with advanced HF, with particular emphasis on oxidative/antioxidative balance parameters. We analyzed 85 heart transplant candidates who were hospitalized at our institution for right heart catheterization. Ten milliliters of coronary sinus blood was collected to measure oxidative/antioxidative markers. The median age was 58 (50-62) years, and 90.6% of them were male. The one-year mortality rate was 40%. Multivariable logistic regression analysis revealed that ceruloplasmin (OR = 1.342 [1.019-1.770], p = 0.0363; per unit decrease), catalase (OR = 1.053 [1.014-1.093], p = 0.0076; per unit decrease), and creatinine (OR = 1.071 [1.002-1.144], p = 0.0422; per unit increase) were independently associated with one-year mortality. Ceruloplasmin, catalase, and creatinine had areas under the curve of 0.9296 [0.8738-0.9855], 0.9666 [0.9360-0.9971], and 0.7682 [0.6607-0.8756], respectively. Lower ceruloplasmin and catalase in the coronary sinus, as well as higher creatinine in peripheral blood, are independently associated with one-year mortality in patients with advanced HF. Catalase and ceruloplasmin have excellent prognostic power, and creatinine has acceptable prognostic power, allowing the distinction of one-year survivors from nonsurvivors.
