title: Prediction of outcome by neurohumoral activation, the six-minute walk test and the Minnesota Living with Heart Failure Questionnaire in an outpatient cohort with congestive heart failure.
abstract: OBJECTIVE
  To compare the precursor of atrial and brain natriuretic peptide (N-ANP, N-BNP), brain natriuretic peptide (BNP), big endothelin-1, the 6-min walk test and the Minnesota Living with Heart Failure Questionnaire (LHFQ) with regard to short-term outcome in an ambulatory heart failure population.
  
  
  RESULTS
  Ninety-six individuals (left ventricular ejection fraction of 26+/-10%) were included in the study. Within 1 day blood samples of N-ANP, N-BNP, BNP and big endothelin-1 were obtained, and the 6-min walk test and LHFQ were measured. The predictive power of these variables - including renin-angiotensin system antagonist therapy - in respect of 1-year event-free survival were calculated with a Cox regression analysis. All investigated variables had the power to predict outcome in a univariate analysis. Multivariate analysis revealed that N-ANP (chi-square=58 P<0.0001), BNP (chi-square=8 P<0.01), the LHFQ (chi-square=6 P<0.02) and the renin-angiotensin system antagonist (chi-square=4 P<0.05), are independent predictors.
  
  
  CONCLUSIONS
  We conclude that, in an open clinical cohort of patients with large differences in the progression of the disease, N-ANP, BNP and LHFQ are the most reliable predictors of worsening heart failure in the short term. However, the dosage of the ACE inhibitor influenced short-term survival in this population.
authors.affiliation: Department of Cardiology, University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Hülsmann
authors.forename: R
authors.initials: R
authors.lastname: Berger
authors.forename: B
authors.initials: B
authors.lastname: Sturm
authors.forename: A
authors.initials: A
authors.lastname: Bojic
authors.forename: W
authors.initials: W
authors.lastname: Woloszczuk
authors.forename: J
authors.initials: J
authors.lastname: Bergler-Klein
authors.forename: R
authors.initials: R
authors.lastname: Pacher
mesh_terms: D000203:Activities of Daily Living; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D015331:Cohort Studies; D019332:Endothelin-1; D016232:Endothelins / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000378:metabolism; D011795:Surveys and Questionnaires; D016138:Walking
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019332:Endothelin-1; D016232:Endothelins; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor