Prediction of Recovery in Heart Failure with Genomic Biomarkers

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Background: We recently developed a transcriptomic based biomarker (TBB) that accurately predicts clinical outcome in patients with heart failure due to dilated cardiomyopathy. Here we tested its performance in a broad population of new onset cardiomyopathy. Methods and Results: A total of 350 patients were followed for a period of 5.6 years after undergoing endomyocardial biopsy at presentation. RNA was isolated from biopsies and hybridized to an Affymetrix U133 microarray. We selected 49 patients with idiopathic cardiomyopathy and new onset heart failure aged 48±4 years (33 male/16 female), who received recommended standard treatment for heart failure, and classified them into BP (n=17) and GP (n=32) based on a TBB of 45 genes. Patients classified as BP had a relative risk of death or transplantation of 4.89 fold vs GP (p<0.0001, hazard ratio: 5.3; 95% CI: 4.0–30.7). Whereas BP patients had no improvement in ejection fraction (EF; 27.1±19.2% and 27.9±18.8%, at baseline vs follow-up, respectively, P=0.34), the GP group exhibited substantial improvement from 30.8±17.3% to 45.0±18.6% (P=0.001, avg. follow-up 4±1.9 years).

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Conclusion: These results demonstrate the value of a transcriptomic biomarker in the discrimination of patients with excellent long-term outcome and ventricular functional recovery from a group with very poor survival. These findings strongly support the value of TBBs in the risk assessment of patients with heart failure and cardiomyopathy.