Combination of B-type natriuretic peptide and peak oxygen consumption improves risk stratification in outpatients with chronic heart failure.
BACKGROUND
Peak oxygen consumption is a cornerstone for prognostic determination in patients with congestive heart failure. The purpose of this study was to assess whether plasma B-type natriuretic peptide (BNP) provided any additional prognostic information.


METHODS
Plasma concentrations of atrial natriuretic peptide, N terminal pro-atrial natriuretic peptide, BNP, endothelin-1, norepinephrine, and peak VO2 were measured in 250 consecutive outpatients with mild to moderate heart failure (96% in New York Heart Association [NYHA] class II or III) and left ventricular ejection fraction (LVEF) <45%.


RESULTS
During a median follow-up of 584 days, 42 patients died (19 from sudden death) and 5 underwent urgent heart transplantation. Multivariate stepwise regression analysis showed that, among 13 variables including NYHA and LVEF, plasma BNP (chi2 = 11.9, P =.0001) was the strongest independent predictor of death or urgent transplantation, followed by serum sodium (chi2 = 8, P =.0046), resting heart rate (chi2 = 7.5, P =.0062), plasma endothelin-1 (chi2 = 7.2, P =.007), and peak VO2 (chi2 = 6.2, P =.012). Patients with plasma BNP above the upper quartile value (260 pg/mL) had a 1-year rate of death or urgent transplantation of 31%. The 1- and 2-year survival rates without urgent transplantation in patients with a peak VO2 < or =14 mL x kg(-1) x min(-1) were 71% and 59%, respectively, when plasma BNP was >137 pg/mL (median value), compared with 100% and 89%, respectively, when plasma BNP was < or =137 pg/mL (P =.008). Furthermore, plasma BNP was the only independent predictor of sudden death (chi2 = 19.9, P =.00001).


CONCLUSIONS
Plasma BNP provides additive independent prognostic information compared to peak VO2 alone in outpatients with mild to moderate heart failure.
Isnard
Richard
R
Service de Cardiologie, Institut Fédératif de Recherche 14 Heart, vessels, muscle UPRES EA 2390, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France. richard.isnard@psl.ap-hop-paris.fr
Pousset
Françoise
F
Chafirovskaïa
Olga
O
Carayon
Alain
A
Hulot
Jean Sébastien
JS
Thomas
Daniel
D
Komajda
Michel
M
D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D019332:Endothelin-1 / Q000097:blood; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D016027:Heart Transplantation; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D012044:Regression Analysis; D012306:Risk; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology; D016277:Ventricular Function, Left
D015415:Biomarkers; D019332:Endothelin-1; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D009638:Norepinephrine