Risk stratification of patients with severe heart failure awaiting heart transplantation – prospective national registry POLKARD HF

Background: Most methods used in the risk assessment of heart transplant
candidates do not include new biomarkers. Aim: The aim of the study was to examine the value of NTproBNP and hsCRP and their combined use together with HFSS score in the risk assessment of patients with heart failure enlisted for heart transplantation.
Material/Methods: Data of 658 patients enlisted for heart transplantation were stored in a prospective registry. The primary (death or urgent transplantation) and the secondary end points (death before OHT) were recorded during the follow-up.
Results: The primary end point was recorded in 161 (24%) of pts; secondary in 102 (15%). The differences were highly significant: in Kaplan Meier curves stratified by the quartiles of NT proBNP for death or urgent transplantation (p<0.000001) and death (p<0.0002) or quartiles according to the hsCRP level on admission, (p<0.002) and (p<0.02). In the multivariate Cox proportional hazard model for death or urgent OHT, the significance was observed in NTproBNP (p<0.01) and HFSS (p<0.02), and borderline significance for hsCRP (p=0.057) for death before OHT, HFSS score P<0.00005, NTproBNP P<0.0005 and hsCRP P<0.01. A modest but significant increase of ROC value was recorded when HFSS score, NTproBNP and hs CRP were included in the model. For death or urgent OHT it was 0.638 and for death before transplantation 0.6943.
Conclusions: HFSS, NTproBNP and hsCRP levels are independent stratification variables of survival or need for urgent heart transplantation and survival before transplantation. Their predictive value is moderately increased when they are analyzed together.

Keywords: Heart Transplantation