Prognostic Value of N-Terminal Pro–Type-B Natriuretic Peptide and Doppler Left Ventricular Diastolic Variables in Patients With Chronic Systolic Heart Failure Stabilized by Therapy (original) (raw)
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International Journal of Cardiology, 2009
Background: In systolic heart failure (HF), preventing the development of severe symptoms, before patients are in advanced NYHA functional classes, is a worthwhile target of therapy. Early recognition of left ventricular (LV) diastolic dysfunction and neuroendocrine activation may have an important impact on patient's outcome. Aim: To investigate whether N-terminal proBNP (NT-proBNP) and mitral flow and tissue Doppler (TD) diastolic parameters are incremental for risk stratification of systolic HF patients in NYHA class I and II. Methods: The study consisted of 232 consecutive outpatients with systolic HF (ejection fraction [EF] ≤45%) in NYHA class I to II. They had a full Doppler two-dimensional-echocardiographic study, including pulsed-Doppler mitral E wave deceleration time (EDT) and TD early septal annular velocity (E′). Plasma NT-proBNP was assessed at the time of the echocardiogram. Results: During a median follow-up of 31 months, there were 65 events (25 deaths and 40 HF-related hospitalizations). Multivariate analysis showed that N-terminal proBNP N 544 pg/ml (hazards ratio [HR]: 2.66; p = 0.012), EF b 37% (HR: 2.45; p = 0.006), E ≤ 8 cm/s (HR: 1.84; p = 0.045) and EDT b 150 ms (HR: 1.78; p = 0.026) significantly correlated with events. On forward stepwise analysis, EDT (p b 0.0001) and E′ (p b 0.0001) provided an incremental contribution to the outcome prediction above and beyond conventional risk markers, that was further increased by the addition of NT-proBNP (p b 0.0001). Conclusion: In patients with systolic HF in NYHA functional class I and II, N-terminal proBNP and LV mitral flow and TD variables of diastolic dysfunction had a strong predictive power for the combined end point of all-cause mortality and HF-related hospitalizations.
Journal of the American Society of Echocardiography, 2006
Background: It was the aim of this study to compare the prognostic impact of echocardiography and brain natriuretic peptide and its N-terminal fragment (NT-proBNP) in patients with chronic heart failure (CHF). Methods: In all, 73 patients with CHF underwent conventional 2-dimensional/Doppler echocardiography and Doppler tissue analysis of systolic, early and late diastolic mitral annular velocities. The mitral filling pattern was classified as restrictive or nonrestrictive. NT-proBNP measurements were carried out on a bench-top analyzer. A cardiac event (rehospitalization caused by worsening CHF, cardiac death, urgent cardiac transplantation) was defined as combined study end point. Results: During follow-up of 226 ؎ 169 days, 27 patients had an event (rehospitalization because of CHF, n ؍ 18; cardiac death, n ؍ 7; urgent transplantation, n ؍ 2). On multivariate Cox regression analysis, a restrictive filling pattern, NT-proBNP, the ratio of peak early diastolic mitral flow to mitral annular E= velocity were independent prognostic predictors. A risk stratification model based on the 3 strongest independent predictors separated groups into those with good, intermediate, and poor outcome (event-free survival of 78%, 46%, and 0%, respectively). Conclusions: In patients with CHF, Doppler echocardiography, Doppler tissue imaging, and NT-proBNP provide independent and incremental prognostic information. A combined use of echocardiography and NT-proBNP may help to improve risk stratification in this patient population.
American Heart Journal, 2008
Background-Echocardiographic indices of cardiac structure and function and natriuretic peptide levels are strong predictors of mortality in patients with heart failure. Whether cardiac ultrasound and natriuretic peptides provide independent prognostic information is uncertain. Methods-Echocardiograms and measurements of N-terminal pro-B type natriuretic peptide (NT-proBNP) were prospectively performed in 211 patients with left ventricular systolic dysfunction who were followed for a median of 4 years. Echocardiographic variables and NT-proBNP were examined as predictors of all-cause mortality in univariable and multivariable proportional hazards models. Results-Participants averaged 57 (SD 12) years of age and had a mean left ventricular ejection fraction of 32 (SD 11) %. A total of 71 patients (34%) died during the follow-up period. NT-ProBNP was a strong predictor of mortality (P < 0.001) as were multiple echocardiographic measures. In models that included age and NT-proBNP, with other clinical variables eligible for entry by stepwise selection, significant predictors of death included left ventricular ejection fraction (P = 0.013) and end-diastolic volume (P < 0.001), left atrial volume index (P = 0.005), right atrial volume index (P = 0.003), and tricuspid regurgitation area (P = 0.015). In models that also included left ventricular ejection fraction, end-diastolic volume of the left ventricle (P = 0.019), left atrial volume (P = 0.026), and right atrial volume (P = 0.020) remained significant predictors of mortality. Conclusions-Left ventricular size and function and left atrial and right atrial sizes are significant predictors of all-cause mortality in patients with heart failure, independent of NT-proBNP levels and other clinical variables. Echocardiography is an important tool in the evaluation of patients with heart failure. A comprehensive two-dimensional and Doppler echocardiogram provides a reliable assessment of left ventricular and right ventricular function and of the severity of associated valvular lesions. In addition to providing insight into the etiology of heart failure,
European Heart Journal, 2004
Aims Comparison of the value of echocardiography and B-type natriuretic peptide (BNP) in monitoring response to treatment in patients admitted for acute heart failure (HF). Methods and results Ninety-five consecutive patients admitted with acute HF underwent bedside Doppler echocardiography and BNP measurements on admission, after 24 h of intravenous treatment, and at day 7. We then studied the association between the clinical status, the Doppler echocardiographic findings, the BNP measurements and subsequent 60-day adverse outcome (death, resuscitated cardiac arrest, urgent heart transplantation, readmission).
The American Journal of Cardiology, 2007
N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and echocardiography have been shown to have diagnostic and prognostic value for the assessment of heart failure (HF) in the community. This study evaluated whether echocardiography and serum NT-pro-BNP estimation have independent value for the prediction of major outcome in patients with suspected HF from the community. Accordingly, 137 patients with suspected HF referred from the community were followed up after undergoing clinical assessment, electrocardiography, NT-pro-BNP estimation, and echocardiography. Abnormal echocardiogram was defined as visual left ventricular ejection fraction <45% or left atrial volume index >26 ml/m 2 or presence of left ventricular hypertrophy or significant valvular heart disease. Data were obtained in 132 patients (96%) over a mean follow-up period of 26 ؎ 7 months during which 19 (14%) developed major cardiac events (14 deaths and 5 HF admissions). Univariate predictors for major cardiac event were age (p ؍ 0.05), male gender (p ؍ 0.007), presence of clinical signs of HF (p ؍ 0.02), NT-pro-BNP level >50 pmol/L (p <0.001), abnormal electrocardiogram (p ؍ 0.02), and abnormal echocardiogram (p ؍ 0.004). However, the only independent predictors were male gender (odds ratio 3.09, 95% confidence interval 1.01 to 9.46, p ؍ 0.05), NT-pro-BNP level >50 pmol/L (odds ratio 5.78, 95% confidence interval 1.63 to 20.5, p ؍ 0.007), and abnormal echocardiogram (odds ratio 11.1, 95% confidence interval 1.43 to 85.6, p ؍ 0.02). In conclusion, NT-pro-BNP and abnormal echocardiogram provided independent information for predicting adverse outcome in patients with suspected HF referred from the community.
The Journal of Heart and Lung Transplantation, 2013
KEY WORDS: heart failure; cardiac transplantation; natriuretic peptide; Seattle Heart Failure Score BACKGROUND: Cardiac transplantation represents the best procedure to improve long-term clinical outcome in advanced chronic heart failure (CHF), if pre-selection criteria are sufficient to outweigh the risk of the failing heart over the risk of transplantation. Although the cornerstone of success, risk assessment in heart transplant candidates is still under-investigated. Amino terminal pro B-type natriuretic peptide (NT-proBNP) is regarded as the best predictor of outcome in CHF, and the Seattle Heart Failure Score (SHFS), including clinical markers, is widely used if NT-proBNP is unavailable. METHODS: The present study assessed the predictive value for all-cause death of the SHFS in CHF patients and compared it with NT-proBNP in a multivariate model including established baseline parameters known to predict survival. RESULTS: A total of 429 patients receiving stable HF-specific pharmacotherapy were included and monitored for 53.4 Ϯ 20.6 months. Of these, 133 patients (31%) died during follow-up. Several established predictors of death on univariate analysis proved significant for the total study cohort. Systolic pulmonary arterial pressure (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.05); p o 0.001, Wald 15.1), logNT-proBNP (HR, 1.51; 95% CI, 1.22-1.86; p o 0.001, Wald 14.9), and the SHFS (HR, 0.99; 95% CI, 0.99-1.00; p o 0.001, Wald 12.6) remained within the stepwise multivariate Cox regression model as independent predictors of all-cause death. Receiver operating characteristic curve analysis revealed an area under the curve of 0.802 for logNT-proBNP and 0.762 for the SHFS. CONCLUSIONS: NT-proBNP is a more potent marker to identify patients at the highest risk. If the NT-proBNP measurement is unavailable, the SHFS may serve as an adequate clinical surrogate to predict all-cause death. J Heart Lung Transplant ]
Plasma B-type natriuretic peptide levels in systolic heart failure
Journal of the American College of Cardiology, 2004
This study was designed to characterize the importance of echocardiographic indexes, including newer indexes of diastolic function, as determinants of plasma B-type natriuretic peptide (BNP) levels in patients with systolic heart failure (SHF). BACKGROUND Plasma BNP levels have utility for diagnosing and managing heart failure. However, there is significant heterogeneity in BNP levels that is not explained by left ventricular size and function alone.