Kanagala, Prathap 
ORCID: 0000-0001-6739-5607, Arnold, Jayanth R, Khan, Jamal N, Singh, Anvesha, Gulsin, Gaurav S, Squire, Iain B, McCann, Gerry P and Ng, Leong L
(2021)
Plasma P-selectin is a predictor of mortality in heart failure with preserved ejection fraction.
ESC HEART FAILURE, 8 (3).
pp. 2328-2333.
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Abstract
<h4>Aims</h4>The aim of the study was to assess the association of P-selectin with outcomes in heart failure with preserved ejection fraction (HFpEF).<h4>Methods and results</h4>This is a prospective, observational study of 130 HFpEF patients who underwent clinical profiling, blood sampling, 6 min walk testing, Minnesota Living with Heart Failure Questionnaire evaluation, echocardiography, cardiovascular magnetic resonance imaging, calculation of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk scores, and blinded plasma P-selectin measurement. Patients were followed up for the endpoint of all-cause mortality. The HFpEF subgroup with higher P-selectin levels [overall median 26 372, inter-quartile range (19 360-34 889) pg/mL] was associated with lower age, higher heart rate, less prevalent atrial fibrillation, more frequent current smoking status, and lower right ventricular end-diastolic volumes. During follow-up (median 1428 days), there were 38 deaths. Following maximal sensitivity and specificity receiver operating characteristic curve analysis, P-selectin levels above 35 506 pg/mL were associated with greater risk of all-cause mortality [hazard ratio (HR) 2.700; 95% confidence interval (CI) 1.416-5.146; log-rank P = 0.002]. Following multivariable Cox proportional hazards regression analysis and when added to MAGGIC scores, only P-selectin (adjusted HR 1.707; 95% CI 1.099-2.650; P < 0.017) and myocardial infarction detected by cardiovascular magnetic resonance imaging (HR 2.377; 95% CI 1.114-5.075; P < 0.025) remained significant predictors. In a final model comprising all three parameters, only P-selectin (HR 1.447; 95% CI 1.130-1.853; P < 0.003) and MAGGIC scores (HR 1.555; 95% CI 1.136-2.129; P < 0.006) remained independent predictors of death. Adding P-selectin (0.618, P = 0.035) improved the area under the receiver operating characteristic curve for mortality prediction for MAGGIC scores (0.647, P = 0.009) to 0.710, P < 0.0001.<h4>Conclusions</h4>Plasma P-selectin is an independent predictor of mortality and provides incremental prognostic information beyond MAGGIC scores in HFpEF.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | P-selectin, Mortality, Heart failure with preserved ejection fraction, Meta-Analysis Global Group in Chronic Heart Failure risk score |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Clinical Directorate |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 10 Oct 2022 08:01 |
| Last Modified: | 18 Jan 2023 20:37 |
| DOI: | 10.1002/ehf2.13280 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3165291 |
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