Document Detail

Independent prognostic value of echocardiography and N-terminal pro-B-type natriuretic peptide in patients with heart failure.
MedLine Citation:
PMID:  19033018     Owner:  NLM     Status:  MEDLINE    
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-brain 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 years old (SD 12 years) and had a mean left ventricular ejection fraction of 32% (SD 11%). A total of 71 patients (34%) died during the follow-up period. N-terminal pro-brain natriuretic peptide was a strong predictor of mortality (P < .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 = .013) and end-diastolic volume (P < .001), left atrial volume index (P = .005), right atrial volume index (P = .003), and tricuspid regurgitation area (P = .015). In models that also included left ventricular ejection fraction, end-diastolic volume of the left ventricle (P = .019), left atrial volume (P = .026), and right atrial volume (P = .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.
Alan L Hinderliter; James A Blumenthal; Christopher O'Conner; Kirkwood F Adams; Carla Sueta Dupree; Robert A Waugh; Daniel Bensimhon; Robert H Christenson; Andrew Sherwood
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2008-10-15
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-26     Completed Date:  2008-12-16     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1191-5     Citation Subset:  AIM; IM    
Division of Cardiology, University of North Carolina, Chapel Hill, NC 27559-7075, USA.
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MeSH Terms
Cause of Death
Follow-Up Studies
Heart Failure / blood,  mortality,  ultrasonography*
Hemodynamics / physiology
Middle Aged
Natriuretic Peptide, Brain / blood*
North Carolina
Peptide Fragments / blood*
Proportional Hazards Models
Prospective Studies
Tricuspid Valve Insufficiency / blood,  mortality,  ultrasonography
Ventricular Dysfunction, Left / blood,  mortality,  ultrasonography*
Grant Support
Reg. No./Substance:
0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain

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