A.E. Berezin, A.A. Kremser.Biological markers in risk evaluation of unfavorable clinical outcomes in patients with ischemic chronic heart failure.

The aim – to create cardiovascular risk score based on analysis of circulating biomarkers of CHF.
Material and methods. We studied prospectively the incidence of fatal and non-fatal cardiovascular events, as well as the frequency of death from any cause in cohort of 388 patients with chronic heart failure during 3 years of observation. Circulating levels of NT-pro brain natriuretic peptide (NT-proBNP), galectin-3, high-sensitivity C-reactive protein (hs-CRP), osteoprotegerin and its soluble receptor sRANKL, osteopontin, osteonectin, adiponectin, endothelial apoptotic microparticles (EAM) and endothelial progenitor cells (EPC) were measured at baseline.
Results. Median follow-up of patients included in the study was 2.76 years (range 1.8–3.4 years). There were 285 cardiovascular events registered, including 43 deaths and 242 readmissions. Independent predictors of clinical outcomes in patients with CHF were NT-proBNP, galectin-3, hs-CRP, osteoprotegerin, sRANKL/osteoprotegerin ratio, CD14+CD309+Tie2+ EPС, EAM and EAM/CD14+CD309+ EPС ratio. Index of cardiovascular risk was calculated by mathematical summation of all ranks of independent predictors, which occurred in the patients included in the study. The average value of the index of cardiovascular risk in patients with CHF was 3.17 units (95 % CI 1.65–5.10 units.). Kaplan – Meier analysis showed that patients with CHF and the magnitude of the risk of less than 4 units have advantage in survival compared to patients with higher values of cardiovascular risk score.
Conclusion. Assessment of biomarker risk score of fatal and non-fatal cardiovascular events, based on measurement of circulating NT-proBNP, galectin-3, hs-CRP, osteoprotegerin, EAM and the ratio of the EAM/CD14 + CD309 + EPС, allows to predict the probability of survival of patients with CHF, regardless of age, gender, contractile function of the left ventricular myocardium and the number of comorbidities.

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