title: Combining blood flow and tissue Doppler imaging with N-terminal pro-type B natriuretic peptide for risk stratification of clinically stable patients with systolic heart failure.
abstract: OBJECTIVE
  This study was designed to ascertain whether the combination of Doppler assessment of the ratio of mitral blood flow to myocardial early diastolic velocities (E/E(m) ratio) and plasma N-terminal pro-type B natriuretic peptide (NT-proBNP) testing is useful to better stratify patients with stable systolic heart failure (HF).
  
  
  RESULTS
  A total of 362 outpatients with chronic systolic HF (left ventricular ejection fraction <or=45%) underwent clinical assessment, NT-proBNP testing, and comprehensive echo-Doppler study. The endpoint was all-cause mortality or HF-related hospital admissions (i.e. hospitalization for worsening HF, biventricular pacemaker implantation, or mitral valve surgery). Median follow-up duration was 25 months. Two hundred and fifty-nine patients were judged clinically stable by a Framingham's criteria-based HF score. In multivariate Cox's proportional hazards analysis, plasma NT-proBNP (P< 0.0001) and E/E(m) ratio (P= 0.04) were among the significant predictors of the combined endpoint. Survival free from cardiac mortality and HF-related hospitalization was 55% in patients with the E/E(m) ratio in the higher third (>or=12), 77% in those with the E/E(m) ratio in the intermediate third, and 86% in those with the E/E(m) ratio in the lower third (<or=7) (P< 0.0001). By stratifying patients according to NT-proBNP above the median, patients' outcome was predicted in 13 out of 17 in the intermediate third (P = 0.002) and in 9 out of 10 in the lower third of E/E(m) ratio (P= 0.005).
  
  
  CONCLUSIONS
  In patients with stable HF categorized according to the E/E(m) ratio, NT-proBNP testing improves risk stratification, particularly in those with minor degrees of diastolic dysfunction.
authors.affiliation: Unità Operativa Malattie Cardiovascolari 1, Dipartimento Cardio-toracico e Vascolare, Università degli Studi di Pisa, Azienda Ospedaliera-Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Rosa
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Valeria
authors.initials: V
authors.lastname: Santonato
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Napoli
authors.forename: Manrico
authors.initials: M
authors.lastname: Ciuti
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D018570:Risk Assessment / Q000379:methods
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain