title: Prognostic value of combined measurement of brain natriuretic peptide and triiodothyronine in heart failure.
abstract: BACKGROUND
  Both low free triiodothyronine (fT3) and high brain natriuretic peptide (BNP) have been separately described as prognostic predictors for mortality in heart failure (HF). We investigated whether their prognostic value is independent.
  
  
  RESULTS
  From January of 2001 to December of 2006, we prospectively evaluated 442 consecutive patients with systolic HF and no thyroid disease or treatment with drugs affecting thyroid function (age 65+/-12 years, mean +/- standard deviation, 75% were male, left ventricular ejection fraction 33% +/- 10%, New York Heart Association (NYHA) class I and II: 63%, NYHA class III and IV: 37%). All patients underwent full clinical and echocardiographic evaluation and assessment of BNP and thyroid function. Both cardiac and all-cause mortality (cumulative) were considered as end points. During a median 36-month follow-up (range 1-86 months), 110 patients (24.8%) died, 64 (14.4%) of cardiac causes. Univariate Cox model predictors of all-cause mortality and cardiac death were age, body mass index, creatinine, hemoglobin, ejection fraction, NYHA class, BNP, fT3, and thyroxine level. Multivariate analysis selected age, NYHA class, hemoglobin, BNP, and fT3 as independent predictors for all-cause mortality and NYHA class, BNP, and fT3 as independent predictors for cardiac mortality. Patients with low fT3 and higher BNP showed the highest risk of all-cause and cardiac death (odds ratio 11.6, confidence interval, 5.8-22.9; odds ratio 13.8, confidence interval, 5.4-35.2, respectively, compared with patients with normal fT3 and low BNP).
  
  
  CONCLUSIONS
  fT3 and BNP hold an independent and additive prognostic value in HF.
authors.affiliation: Department of Cardiovascular Medicine, G. Monasterio Foundation, CNR-Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.forename: Marianna
authors.initials: M
authors.lastname: Fontana
authors.forename: Luc
authors.initials: L
authors.lastname: Zyw
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iervasi
mesh_terms: D000368:Aged; D015415:Biomarkers; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D014284:Triiodothyronine; D020097:Natriuretic Peptide, Brain; D013974:Thyroxine