title: [Brain natriuretic peptide and QRS duration as a predictor for cardiac events in patients with heart failure].
abstract: OBJECTIVE
  Brain natriuretic peptide (BNP) and QRS duration have been reported as independent predictors for cardiac events in patients with heart failure. The present study investigated the relationships between BNP and QRS duration to assess the prognostic value in patients with heart failure.
  
  
  METHODS
  We prospectively examined 93 patients presenting to our emergency department with heart failure between April 2000 and April 2003 (age 69 +/- 13 years, 53 males, 40 females). BNP level and QRS duration were measured after treatment for heart failure. The efficacy end point was the composite incidence of sudden death, death for progressive heart failure, or readmission for worsening heart failure.
  
  
  RESULTS
  During the mean follow-up period of 720 +/- 470 days, cardiac events occurred in 35 patients (sudden death in 6, death for progressive heart failure in 9, and readmission for worsening heart failure in 20). BNP level was almost equally higher in the three groups with cardiac events (mean +/- SEM; sudden death: 348 +/- 128 pg/ml, death for progressive heart failure: 390 +/- 97 pg/ml, readmission for worsening heart failure: 354 +/- 79 pg/ml) than in patients without cardiac events (213 +/- 34 pg/ml). In contrast, QRS duration was exclusively prolonged in patients with sudden death(mean +/- SEM, 125 +/- 10 msec) compared with the remaining three groups (death for progressive heart failure: 100 +/- 5 msec, readmission for worsening heart failure: 103 +/- 4 msec, no cardiac events: 108 +/- 3 msec). No relationship was found between BNP level and QRS duration in all patients with heart failure (Spearman r = 0.13, p = 0.22).
  
  
  CONCLUSIONS
  Increased BNP level was associated with poor prognosis irrespective of mode of cardiac events, and prolonged QRS duration was related to sudden death in our cohort with heart failure. The combination of BNP level and QRS duration may have adjunctive value in predicting the prognosis in patients with heart failure.
authors.affiliation: Department of Cardiology, Matsushita Memorial Hospital, Osaka. cytokine@nike.eonet.ne.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Taniguchi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyai
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Kamitani
authors.forename: Shingo
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugihara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D020097:Natriuretic Peptide, Brain