title: Combination of B-type natriuretic peptide and minute ventilation/carbon dioxide production slope improves risk stratification in patients with diastolic heart failure.
abstract: BACKGROUND
  Recent studies demonstrated that the minute ventilation/carbon dioxide production (VE/VCO(2)) slope more powerfully predicted mortality, hospitalization, or both than peak oxygen consumption (VO(2)) in systolic heart failure. However, the prognostic values of these two parameters in diastolic heart failure remained unclear.
  
  
  METHODS
  The patients with diastolic heart failure were recruited from April 2006 to May 2007, and underwent cardiopulmonary exercise testing. Plasma BNP concentration was measured using Triage BNP immunoassay method.
  
  
  RESULTS
  Of the 224 patients enrolled, mean values for age and New York Heart Association (NYHA) class were 68.8 ± 9.0 years and 2.38 ± 0.53, respectively. During the mean follow-up of 30 months, 57 patients died (36 from cardiovascular death). Univariate Cox regression analysis showed that age, NYHA class, atrial fibrillation, diabetes mellitus, left ventricular diastolic dysfunction, peak VO(2), VE/VCO(2) slope, and plasma BNP were significantly associated with mortality. Multivariate analysis revealed that plasma BNP, VE/VCO(2) slope, and age remained independent predictors for cardiovascular and all-cause mortalities, with the strongest prognostic power of plasma BNP (χ(2) ≥ 31.4, P < 0.001). In addition to plasma BNP and clinical predictors, the VE/VCO(2) slope could provide independent and incremental prognostic value of cardiovascular (χ(2) = 60.6 vs 51.7; P = 0.009) and all-cause mortalities (χ(2) = 62.8 vs 54.2; P = 0.015) with increased χ(2) value of Cox regression model.
  
  
  CONCLUSIONS
  In diastolic heart failure, plasma BNP is the strongest predictor of mortality, and VE/VCO(2) slope provides independent and additive prognostic information, which suggests that combination of plasma BNP and VE/VCO(2) slope can improve risk stratification.
authors.affiliation: Intensive Care Unit, Zhejiang Hospital, Lingyin Road 12, Hangzhou 310013, China. yanjing2011@yahoo.com.cn
authors.forename: Jing
authors.initials: J
authors.lastname: Yan
authors.forename: Shi-Jin
authors.initials: SJ
authors.lastname: Gong
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Yu
authors.forename: Hai-Wen
authors.initials: HW
authors.lastname: Dai
authors.forename: Jin
authors.initials: J
authors.lastname: Chen
authors.forename: Cheng-Wu
authors.initials: CW
authors.lastname: Tan
authors.forename: Qiang-Hong
authors.initials: QH
authors.lastname: Xv
authors.forename: Guo-Long
authors.initials: GL
authors.lastname: Cai
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood*; D005080:Exercise Test / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D054144:Heart Failure, Diastolic / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012123:Pulmonary Ventilation / Q000502:physiology*; D018570:Risk Assessment / Q000639:trends
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002245:Carbon Dioxide