title: Prognostic role of echocardiography and brain natriuretic peptide in symptomatic breathless patients in the community.
abstract: OBJECTIVE
  Brain natriuretic peptide (BNP), left ventricular (LV) systolic function, and mitral filling pattern (MFP) are prognostic indicators in patients with heart failure (HF). This study evaluated the potential role of E/Ea for predicting cardiovascular (CV) events in patients with suspected HF. This non-invasive measure of LV filling pressure has been shown to predict outcome in more advanced HF, but not in mild HF in the community.
  
  
  RESULTS
  Two hundred and twenty-eight elderly symptomatic general practice patients (dyspnoea/oedema) were recruited and underwent clinical evaluation, NT-proBNP assay, and comprehensive echocardiography. The Kaplan-Meier analysis of time to first CV hospitalization or CV death was performed for 1 year after presentation according to nominated thresholds of LV systolic function, NT-proBNP, MFP, and E/Ea ratio. Mean age was 70.3 +/- 7.3 years, mean NT-proBNP was 111.4 +/- 185.8, and 148 (65%) were female. Twenty-six patients (11%) experienced a CV event within 18 months of baseline (6 deaths and 20 admissions). Time to first CV event predicted by NT-proBNP (P < 0.0001), MFP (P = 0.009), and E:Ea (P = 0.0076), but not EF (P = 0.098). When NT-proBNP was elevated, E:Ea >15 identified a group of patients with lower survival (P < 0.0001).
  
  
  CONCLUSIONS
  Both E/Ea and NT-proBNP predicted hospitalization and when used in a two-step approach (NT-proBNP first, followed by E/Ea), the combination of both (elevated NT-proBNP and elevated E/Ea) identified those patients at highest risk, thus supporting a complementary approach for echocardiography and NT-proBNP in patients with HF symptoms.
authors.affiliation: Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92 019, Auckland, New Zealand. g.whalley@auckland.ac.nz
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.forename: Susan P
authors.initials: SP
authors.lastname: Wright
authors.forename: Ann
authors.initials: A
authors.lastname: Pearl
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Walsh
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001783:Blood Flow Velocity / Q000502:physiology; D004417:Dyspnea / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*; D004452:Echocardiography / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain