title: B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure.
abstract: 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.
authors.affiliation: Service de Cardiologie C, Hôpital Cardiologique, CHRU de Lille, France. pdegroote@chru-lille.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: de Groote
authors.forename: Joël
authors.initials: J
authors.lastname: Dagorn
authors.forename: Benoit
authors.initials: B
authors.lastname: Soudan
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.forename: Eugene
authors.initials: E
authors.lastname: McFadden
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
mesh_terms: 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
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain