B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure.
OBJECTIVE
The aim of this study was to compare the prognostic value of peak oxygen consumption (VO(2)) and B-type natriuretic peptide (BNP) in patients with stable congestive heart failure (CHF).


BACKGROUND
Previous studies have demonstrated that both peak VO(2) and BNP are useful for risk stratification in patients with CHF. No study has compared the respective prognostic value of these two parameters in a large series of patients receiving a combination of angiotensin-converting enzyme inhibitors and of beta-blockers.


METHODS
Patients with stable CHF underwent radionuclide angiography, echocardiography, 24-h Holter monitoring, and a cardiopulmonary exercise test. Blood samples were drawn for standard measurements and for hormonal determinations.


RESULTS
After a median follow-up period of 787 days, there were 75 cardiac-related deaths and three urgent transplantations. Independent predictors of cardiac survival were percent of maximal predicted VO(2) (%VO(2), relative risk [RR] = 2.84 [95% confidence interval, CI = 1.73 to 4.65], p < 0.00001), BNP (RR = 3.17 [95% CI 1.68 to 5.96], p = 0.0004), left atrial diameter (LAD) (RR = 2.04 [95% CI 1.25 to 3.34], p = 0.004), age (RR = 1.93 [95% CI 1.22 to 3.05], p = 0.005), and aldosterone (RR = 1.84 [95% CI 1.12 to 3.00], p = 0.015). In patients with infra-median levels of BNP (<109 pg/ml), age was the only independent predictor of cardiac survival. However, in patients with supra-median levels of BNP, independent predictors of cardiac survival were %VO(2) (RR = 3.76 [95% CI 2.19 to 6.45], p < 0.00001) and LAD (RR = 1.90 [95% CI 1.10 to 3.28], p = 0.02).


CONCLUSIONS
B-type natriuretic peptide, in combination with %VO(2), improves risk stratification of patients with stable CHF.
de Groote
Pascal
P
Service de Cardiologie C, Hôpital Cardiologique, CHRU de Lille, France. pdegroote@chru-lille.fr
Dagorn
Joël
J
Soudan
Benoit
B
Lamblin
Nicolas
N
McFadden
Eugene
E
Bauters
Christophe
C
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D005080:Exercise Test; D005500:Follow-Up Studies; D005602:France; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain