title: N-terminal protype-B natriuretic peptide and Doppler diastolic variables are incremental for risk stratification of patients with NYHA class I-II systolic heart failure.
abstract: BACKGROUND
  In systolic heart failure (HF), preventing the development of severe symptoms, before patients are in advanced NYHA functional classes, is a worthwhile target of therapy. Early recognition of left ventricular (LV) diastolic dysfunction and neuroendocrine activation may have an important impact on patient's outcome.
  
  
  OBJECTIVE
  To investigate whether N-terminal proBNP (NT-proBNP) and mitral flow and tissue Doppler (TD) diastolic parameters are incremental for risk stratification of systolic HF patients in NYHA class I and II.
  
  
  METHODS
  The study consisted of 232 consecutive outpatients with systolic HF (ejection fraction [EF] <or=45%) in NYHA class I to II. They had a full Doppler two-dimensional-echocardiographic study, including pulsed-Doppler mitral E wave deceleration time (EDT) and TD early septal annular velocity (E'). Plasma NT-proBNP was assessed at the time of the echocardiogram.
  
  
  RESULTS
  During a median follow-up of 31 months, there were 65 events (25 deaths and 40 HF-related hospitalizations). Multivariate analysis showed that N-terminal proBNP >544 pg/ml (hazards ratio [HR]: 2.66; p=0.012), EF <37% (HR: 2.45; p=0.006), E <or=8 cm/s (HR: 1.84; p=0.045) and EDT <150 ms (HR: 1.78; p=0.026) significantly correlated with events. On forward stepwise analysis, EDT (p<0.0001) and E' (p<0.0001) provided an incremental contribution to the outcome prediction above and beyond conventional risk markers, that was further increased by the addition of NT-proBNP (p<0.0001).
  
  
  CONCLUSIONS
  In patients with systolic HF in NYHA functional class I and II, N-terminal proBNP and LV mitral flow and TD variables of diastolic dysfunction had a strong predictive power for the combined end point of all-cause mortality and HF-related hospitalizations.
authors.affiliation: Unità Operativa Malattie Cardiovascolari 2, Ospedale S Chiara, Azienda Ospedaliera-Universitaria Pisana, 56126 Pisa, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Simona
authors.initials: S
authors.lastname: Buralli
authors.forename: Erica
authors.initials: E
authors.lastname: Panicucci
authors.forename: Diana
authors.initials: D
authors.lastname: Andreini
authors.forename: Umberto
authors.initials: U
authors.lastname: Conti
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: De Tommasi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003971:Diastole; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013599:Systole
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain