| Multiparametric risk stratification in patients with mild to moderate chronic heart failure. | |
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MedLine Citation:
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PMID: 17675058 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiac failure Volume: 13 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2007 Aug |
Date Detail:
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Created Date: 2007-08-06 Completed Date: 2007-09-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 445-51 Citation Subset: IM |
Affiliation:
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Department of Cardiology, S. Spirito Hospital, Rome, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biological Markers / blood Breath Tests Carbon Dioxide / metabolism Disease Progression Echocardiography, Doppler Exercise Test Female Fluoroimmunoassay Follow-Up Studies Heart Failure / blood, diagnosis*, physiopathology Humans Male Middle Aged Natriuretic Peptide, Brain / blood* Outpatients Oxygen / metabolism Prognosis Prospective Studies Risk Assessment Severity of Illness Index Stroke Volume / physiology* |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 114471-18-0/Natriuretic Peptide, Brain; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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