title: Prognostic value of N-terminal pro-type-B natriuretic peptide and Doppler left ventricular diastolic variables in patients with chronic systolic heart failure stabilized by therapy.
abstract: Prognostication of patients with chronic heart failure (HF) stabilized by therapy may be difficult. Therefore, the aim was to evaluate whether combined assessment of plasma N-terminal pro-B natriuretic peptide (NT-pro-BNP) and Doppler left ventricular (LV) diastolic variables was relevant to the prognosis of patients with stable HF. Outpatients with LV systolic HF (ejection fraction < or =45%), classified using clinical criteria as decompensated (n = 94) and stable HF (n = 219), underwent a complete Doppler echocardiographic study. NT-pro-BNP was measured together with mitral wave velocities, E wave deceleration time, and tissue Doppler early septal annular velocity. Median follow-up was 22 months. Freedom from all-cause mortality or HF hospitalization at 24 months was worst (44%) in patients with decompensated HF, intermediate (58%) in patients with stable HF with NT-pro-BNP higher than the median (>1,129 pg/ml), and best (92%) in patients with lower NT-pro-BNP (log-rank p <0.0001). In patients with stable HF, NT-pro-BNP >1,129 pg/ml (hazard ratio [HR] 2.84, p = 0.003), E wave deceleration time <150 ms (HR 2.31, p = 0.004), and tissue Doppler early septal annular velocity <8 cm/s (HR 2.18, p = 0.01) were predictors of the end point at multivariate analysis. The addition of Doppler LV diastolic variables and NT-pro-BNP significantly improved the chi-square test for outcome prediction (from 14.4 to 46.4). In conclusion, NT-pro-BNP and spectral and tissue Doppler variables of LV diastolic dysfunction added independent and incremental contributions to prognostic stratification of patients with stable HF.
authors.affiliation: Unità Malattie Cardiovascolari 2, Santa Chiara Hospital, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Umberto
authors.initials: U
authors.lastname: Conti
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Diana
authors.initials: D
authors.lastname: Andreini
authors.forename: Erica
authors.initials: E
authors.lastname: Panicucci
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: De Tommasi
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006346:Heart Septum / Q000473:pathology; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole; D018608:Ultrasonography, Doppler; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain