title: B-type natriuretic peptide and impedance cardiography at the time of routine echocardiography predict subsequent heart failure events.
abstract: BACKGROUND
  Detection of heart failure (HF) in stable outpatients can be difficult until an overt event occurs. This study sought to determine whether the combination of B-type natriuretic peptide (BNP) and impedance cardiography (ICG) could be used in a nonacute clinical setting to risk stratify and predict HF-related events in stable outpatients.
  
  
  RESULTS
  Patients undergoing routine outpatient echocardiography underwent ICG and BNP testing and were followed for one year for HF-related events (Emergency Department [ED] visit or hospitalization due to HF or all-cause death). A total of 524 patients were analyzed, resulting in 57 HF-related events; 16 ED visits, 17 hospitalizations, and 24 all-cause deaths. Using Cox regression analyses, BNP and systolic time ratio index (STRI) by ICG proved to be the strongest predictors of future HF-related events. Patients with a BNP >100 pg/ml and STRI >0.45 sec(-1) had a significantly lower event-free survival rate than those with a high BNP and low STRI (67% versus 89%, P=.001). In patients with LV dysfunction only, if both BNP and STRI values were high, the relative risk of a HF-related event increased by 12.5 (95 % C.I. 4.2-36.7), when compared with patients with a low BNP and low STRI (P<.001).
  
  
  CONCLUSIONS
  In a nonacute clinical setting, both BNP and ICG testing can provide unique predictive power of long-term HF-related events in a stable cohort of patients with and without LV dysfunction.
authors.affiliation: Division of Cardiology, Department of Medicine Veteran's Affairs San Diego Healthcare System, La Jolla, CA 92161, USA.
authors.forename: Luis R
authors.initials: LR
authors.lastname: Castellanos
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.forename: Susan
authors.initials: S
authors.lastname: Isakson
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Meenakshi A
authors.initials: MA
authors.lastname: Bhalla
authors.forename: Jeannette P
authors.initials: JP
authors.lastname: Lin
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Nancy
authors.initials: N
authors.lastname: Gardetto
authors.forename: Max
authors.initials: M
authors.lastname: Hoshino
authors.forename: Albert
authors.initials: A
authors.lastname: Chiu
authors.forename: Robert
authors.initials: R
authors.lastname: Fitzgerald
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000368:Aged; D002307:Cardiography, Impedance; D015331:Cohort Studies; D016001:Confidence Intervals; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors; D018487:Ventricular Dysfunction, Left
chemical_list: D020097:Natriuretic Peptide, Brain