Abstract 3595: Comparative Predictors of Mortality and Urgent Transplantation in Patients With Advanced Heart Failure
Background: B-type natriuretic peptide (BNP), peak oxygen consumption (VO2), blood urea nitrogen (BUN), systolic blood pressure (SBP), and pulmonary capillary wedge pressure (PCWP) are all well-known predictors of mortality or urgent transplantation in patients with advanced heart failure (HF), but it is unclear which has the strongest prognostic power.
Objective: This study sought to compare the predictive power of BNP, VO2, BUN, SBP and PCWP in patients with advanced heart failure.
Methods: We analyzed 1,215 patients with advanced HF (43% ischemic etiology, 75% male, 75% New York Heart Association class III or IV, age 53±13, left ventricular ejection fraction 23±7%) referred to a university center between 1999 and 2009. BNP and BUN were measured at initial referral, whereas VO2, SBP and PCWP were measured after optimization of hemodynamics via right heart catheterization. Patients were divided into groups based on best cut-offs for predicting both one and two-year mortality from analysis of receiver operating characteristic (ROC) curves (BNP ≥579, VO2 <14, BUN ≥53, SBP <118, and PCWP ≥21).
Results: During a follow-up of 2-years, 234 patients (19%) died, and 208 (17%) required urgent transplantation. Area under the ROC curve (AUC) was 0.756 for BNP, 0.701 for VO2, 0.659 for BUN, 0.638 for SBP, and 0.650 for PCWP. In univariate analyses, BNP (OR=4.3, 95% CI 3.3–5.5) and VO2 (OR=4.5, 95% CI 2.6 –7.8) were the strongest predictors for death or urgent transplantation, as well as all-cause mortality. In multivariate analyses, BNP and VO2 remained the strongest predictors for both death or urgent transplantation and all-cause mortality. Patients with both BNP ≥579 and VO2 <14, compared to those with neither, had 3.1 (95% CI 1.6 – 6.1) times greater risk of all-cause mortality at two year follow-up.
Conclusions: Of five prognostic parameters in advanced HF, BNP and VO2 are the strongest predictors of both death or urgent transplantation and all-cause mortality.