Additive Value of Biomarkers and Echocardiography to Stratify the Risk of Death in Heart Failure Patients with Reduced Ejection Fraction

Table 4

Multivariable Cox model.

Predictor	Model with biomarkers	value	Model without biomarkers	value
	HR (95% CI)		HR (95% CI)
TAPSE/PASP ratio
<0.36	1	<0.001	1	<0.001
≥0.36	0.35 (0.29–0.43)	<0.001	0.29 (0.26–0.33)	<0.001
Unavailable	0.30 (0.12–0.72)	0.007	0.26 (0.12–0.55)	<0.001
Number of biomarkers over threshold (NPs and hsTnI)^^			—	—
0	1	<0.001
1	1.61 (0.79–3.25)	0.188
2	2.60 (1.38–4.90)	0.003
EDT (msec)
≥140	1	0.085	1	0.154
<140	0.80 (0.61–1.03)		0.84 (0.66–1.07)
Age
≤66	1	0.057	1	0.038
>66	2.09 (0.98–4.48)		2.11 (1.04–4.25)
Sex
M	1	0.002	1	0.001
F	1.73 (1.22–2.45)		1.88 (1.32–2.68)
Model value	<0.001	—	<0.001	—
Harrell’s c (95% CI)	0.68 (0.60–0.77)		0.65 (0.54–0.76)
Akaike information criterion	474		480

TAPSE: tricuspid annular plane systolic excursion; PASP: pulmonary artery systolic pressure; NPs: natriuretic peptides; hsTnI: high-sensitivity troponin I; NPs: natriuretic peptides (brain natriuretic peptide (BNP) and N-Terminal-proBNP (NT-proBNP)); biomarker thresholds are >125 pg/ml for BNP, >1016 pg/ml for NT-proBNP, and >0.027 pg/ml for hsTnI; EDT: mitral inflow E velocity deceleration time. ^{^}Test for linearity of effect : there is a linear increase in risk of death with increasing number of positive biomarker; HR_{[2 vs. 1]} 1.62, 95% CI 1.31–2.00, .