Risk stratification in chronic heart failure: independent and incremental prognostic value of echocardiography and brain natriuretic peptide and its N-terminal fragment.
BACKGROUND
It was the aim of this study to compare the prognostic impact of echocardiography and brain natriuretic peptide and its N-terminal fragment (NT-proBNP) in patients with chronic heart failure (CHF).


METHODS
In all, 73 patients with CHF underwent conventional 2-dimensional/Doppler echocardiography and Doppler tissue analysis of systolic, early and late diastolic mitral annular velocities. The mitral filling pattern was classified as restrictive or nonrestrictive. NT-proBNP measurements were carried out on a bench-top analyzer. A cardiac event (rehospitalization caused by worsening CHF, cardiac death, urgent cardiac transplantation) was defined as combined study end point.


RESULTS
During follow-up of 226 +/- 169 days, 27 patients had an event (rehospitalization because of CHF, n = 18; cardiac death, n = 7; urgent transplantation, n = 2). On multivariate Cox regression analysis, a restrictive filling pattern, NT-proBNP, the ratio of peak early diastolic mitral flow to mitral annular E' velocity were independent prognostic predictors. A risk stratification model based on the 3 strongest independent predictors separated groups into those with good, intermediate, and poor outcome (event-free survival of 78%, 46%, and 0%, respectively).


CONCLUSIONS
In patients with CHF, Doppler echocardiography, Doppler tissue imaging, and NT-proBNP provide independent and incremental prognostic information. A combined use of echocardiography and NT-proBNP may help to improve risk stratification in this patient population.
Bruch
Christian
C
Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany. bruchc@uni-muenster.de
Rothenburger
Markus
M
Gotzmann
Michael
M
Sindermann
Juergen
J
Scheld
Hans H
HH
Breithardt
Günter
G
Wichter
Thomas
T
D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010446:Peptide Fragments / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain