Abstract
This prospective study aimed to determine the effect of adding apelin to the MAGGIC (Meta-Analysis Global Group In Chronic Heart Failure) and HFSS (Heart Failure Survival Score) scales for predicting one-year mortality in 240 ambulatory patients accepted for heart transplantation (HT) between 2015–2017. The study also investigated whether the combination of N-terminal pro-brain natriuretic peptide (NT-proBNP) with MAGGIC or HFSS improves the ability of these scales to effectively separate one-year survivors from non-survivors on the HT waiting list. The median age of the patients was 58.0 (51.50.0–64.0) years and 212 (88.3%) of them were male. Within a one year follow-up, 75 (31.2%) patients died. The area under the curves (AUC) for baseline parameters was as follows—0.7350 for HFSS, 0.7230 for MAGGIC, 0.7992 for apelin and 0.7028 for NT-proBNP. The HFSS-apelin score generated excellent power to predict the one-year survival, with the AUC of 0.8633 and a high sensitivity and specificity (80% and 78%, respectively). The predictive accuracy of MAGGIC-apelin score was also excellent (AUC: 0.8523, sensitivity of 75%, specificity of 79%). The addition of NT-proBNP to the HFSS model slightly improved the predictive power of this scale (AUCHFFSS-NT-proBNP: 0.7665, sensitivity 83%, specificity 60%), while it did not affect the prognostic strength of MAGGIC (AUCMAGGIC-NT-proBNP: 0.738, sensitivity 71%, specificity 69%). In conclusion, the addition of apelin to the HFSS and MAGGIC models significantly improved their ability to predict the one-year survival in patients with advanced HF. The MAGGIC-apelin and HFSS-apelin scores provide simple and powerful methods for risk stratification in end-stage HF patients. NT-proBNP slightly improved the prognostic power of HFSS, while it did not affect the predictive power of MAGGIC.
Highlights
The population of patients with end-stage heart failure (HF) is steadily growing due to a worldwide increase in life expectancy, as well as a more effective pharmacological and interventional treatment of the disease [1,2,3]
Despite a number of tests performed in the course of the qualification process for heart transplantation (HT), there is still a great need to find additional prognostic tools for evaluating the prognosis on HT waiting list in patients with end-stage HF
The Heart Failure Survival Score (HFSS) model was developed in the 1990s by Aaronson from a single center cohort of 268 ambulatory patients referred for HT evaluation and has been prospectively validated in a similar group of 199 patients [11]
Summary
The population of patients with end-stage heart failure (HF) is steadily growing due to a worldwide increase in life expectancy, as well as a more effective pharmacological and interventional treatment of the disease [1,2,3]. An increasing number of ambulatory patients with end-stage HF are entered on transplant waiting lists, whereas the number of potential heart donors steadily decreased over the past decade [4,5,6]. There are many risk models with their own set of advantages and disadvantages in end-stage HF, including the Heart Failure Survival Score (HFSS) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score [11,14], there is still a critical need to improve reliable prognostic tools in ambulatory patients listed for heart transplantation (HT). We investigated whether the combination of N-terminal pro-brain natriuretic peptide (NT-proBNP) with MAGGIC or HFSS improved the prognostic strength of these scales in our study population
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