title: Predictive importance of left ventricular myocardial stiffness for the prognosis of patients with congestive heart failure.
abstract: OBJECTIVE
  This study was designed to determine the prognostic importance of left ventricular (LV) myocardial stiffness, a hemodynamic index which is closely related to B-type natriuretic peptide (BNP) concentration in patients with congestive heart failure (CHF).
  
  
  BACKGROUND
  While elevated BNP, an abnormality of cardiac neurohormones, is known to be an independent marker of death or re-admission, it remains to be clarified whether there is also a strong predictor directly related to cardiac dysfunction.
  
  
  METHODS
  LV performance variables and stress-strain analyses including diastolic myocardial stiffness constant (K(m)) were obtained from 37 patients with initial CHF by the combined simultaneous measurement of echocardiographic and hemodynamic data. Survivors were monitored for a mean of 23 months, with the main endpoint being combined death or first re-admission for CHF.
  
  
  RESULTS
  Ten patients (27%) were primary endpoint cases. Both K(m) and plasma BNP levels were higher in the event than in the event-free group. By Cox proportional hazards analysis, K(m)≥4.0 was identified as the only variable with significant and independently incremental predictive power to affect the primary endpoint (adjusted hazard ratio=7.354, 95% confidence interval 1.379-39.232, p=0.02).
  
  
  CONCLUSIONS
  In patients with CHF, increased myocardial stiffness may have greater prognostic significance compared to other conventional predictors. Increased myocardial stiffness may be considered to be an important prognostic factor independent of the loading conditions.
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. swatanabe6119@jazz.odn.ne.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takaoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tanino
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ogasawara
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sawada
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokoyama
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003971:Diastole / Q000502:physiology; D005260:Female; D005544:Forecasting; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain