Document Detail


Prognostic value of brain natriuretic peptide and enhanced ventilatory response to exercise in patients with chronic heart failure.
MedLine Citation:
PMID:  18560771     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Whether brain natriuretic peptide (BNP), combined with a cardiopulmonary exercise test (CPx) parameters or echocardiography improves prognostic stratification in mild-to-moderate systolic heart failure (HF) is currently unclear. In 156 consecutive stable outpatients with mild to moderate HF and left ventricular ejection fraction (LVEF) <40%, we assessed the impact of BNP assay, Doppler echocardiography and CPx on survival. Median BNP plasma levels were 207 [90-520] pg/mL. Mean LVEF was 33 +/- 7%. Left bundle branch block (LBBB) was present in 52 patients (33%) and a restrictive filling pattern in 35 (22%). The slope of the relation between minute ventilation and carbon dioxide production (VE/VCO(2) slope) averaged 35 +/- 8; an enhanced ventilatory response (EVR) to exercise (VE/VCO(2) slope >35) was found in 67 patients (43%). During 759 +/- 346 days of follow-up, 24 patients died. By multivariate analysis, the strongest independent predictors of all-cause death among clinical, echocardiographic variables and BNP were LBBB and beta-blocker treatment. When CPx variables were added, the best predictors of mortality were LBBB, beta-blockade and VE/VCO(2) slope. This study highlights the value of a sequential approach, based on clinical, laboratory and functional data to identify high-risk HF patients. BNP assay might constitute a simple alternative tool for patients with an inability or with clinical contraindications to exercise, advanced physical deconditioning and unreliable CPx results. However, whenever feasible, CPx with assessment of EVR is recommended for a more accurate prediction of prognosis.
Authors:
Angela Beatrice Scardovi; Renata De Maria; Andrea Celestini; Claudio Coletta; Nadia Aspromonte; Silvia Perna; Marina Parolini; Roberto Ricci
Publication Detail:
Type:  Journal Article     Date:  2008-06-17
Journal Detail:
Title:  Internal and emergency medicine     Volume:  3     ISSN:  1970-9366     ISO Abbreviation:  -     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-12     Completed Date:  2009-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101263418     Medline TA:  Intern Emerg Med     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  331-7     Citation Subset:  IM    
Affiliation:
Cardiology Department, S Spirito Hospital, Rome, Italy. ab.scardovi@libero.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Bundle-Branch Block / physiopathology,  ultrasonography
Exercise / physiology*
Exercise Test*
Female
Heart Failure, Systolic / physiopathology*,  ultrasonography
Humans
Male
Multivariate Analysis
Natriuretic Peptide, Brain / blood*
Prognosis
Prospective Studies
Pulmonary Ventilation / physiology*
Risk Assessment
Stroke Volume
Chemical
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain
Comments/Corrections
Comment In:
Intern Emerg Med. 2009 Aug;4(4):353-4; author reply 355   [PMID:  19357823 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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