Document Detail

Multiparametric risk stratification in patients with mild to moderate chronic heart failure.
MedLine Citation:
PMID:  17675058     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Whether brain natriuretic peptide (BNP) combined with cardiopulmonary exercise test (CPx) and echocardiographic findings improves prognostic stratification in mild-to-moderate systolic heart failure (HF) is unclear. METHODS AND RESULTS: A total of 244 consecutive stable outpatients, median age of 71 (62-76) years, with New York Heart Association (NYHA) Class I-III HF and left ventricular ejection fraction (LVEF) < 45% underwent BNP measurement, Doppler echocardiography, and a maximal CPx. Median BNP was 166 (70-403) pg/mL, median LVEF 35% (28%-40%). A restrictive filling pattern (RFP) was present in 44 patients (18%). At CPx, peak oxygen uptake was 12 (9.7, 14.4) mL/kg/min and an enhanced ventilatory response to exercise (EVR, slope of the ventilation to CO2 production ratio, > or = 35) was found in 90 patients (37%) During 18 (9-37) follow-up months, 80 patients died or were admitted for worsening HF (33%). In addition to simple bedside clinical variables (NYHA Class III, creatinine clearance, hemoglobin), BNP levels were predictive of outcome (HR 1.35 [1.12-1.63]). However, both RFP (HR 3.36 [2.09-5.41]) and a steeper minute ventilation-carbon dioxide output slope (HR 1.50 [1.19-1.88]) outperformed BNP as prognostic markers. Patients with both RFP and EVR had a 7.30 (95% CI 4.02-13.25) HR for death or HF-admission versus subjects with neither predictor. CONCLUSIONS: This study highlights the importance of a multiparametric approach for optimal risk stratification in the elderly with mild-to-moderate HF. Patients at high risk should undergo closer follow-up and be carefully evaluated for different therapeutic options, including nonpharmacologic treatment.
Angela Beatrice Scardovi; Renata De Maria; Claudio Coletta; Nadia Aspromonte; Silvia Perna; Giuseppe Cacciatore; Marina Parolini; Roberto Ricci; Vincenzo Ceci
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiac failure     Volume:  13     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-06     Completed Date:  2007-09-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  445-51     Citation Subset:  IM    
Department of Cardiology, S. Spirito Hospital, Rome, Italy.
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MeSH Terms
Biological Markers / blood
Breath Tests
Carbon Dioxide / metabolism
Disease Progression
Echocardiography, Doppler
Exercise Test
Follow-Up Studies
Heart Failure / blood,  diagnosis*,  physiopathology
Middle Aged
Natriuretic Peptide, Brain / blood*
Oxygen / metabolism
Prospective Studies
Risk Assessment
Severity of Illness Index
Stroke Volume / physiology*
Reg. No./Substance:
0/Biological Markers; 114471-18-0/Natriuretic Peptide, Brain; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

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