title: Transthoracic bioimpedance and brain natriuretic peptide assessment for prognostic stratification of outpatients with chronic systolic heart failure.
abstract: BACKGROUND
  In patients with chronic heart failure, physical evaluation and clinical judgment may be inadequate for prognostic stratification.
  
  
  OBJECTIVE
  Information obtained with simple bedside tests would be helpful in patient management.
  
  
  METHODS
  We report on 142 outpatients with systolic heart failure seen at our heart failure unit from 2007 to 2010 (ages 69.4 ± 8.9 years; ejection fraction [EF] 30.6 ± 6.1%; 43% with implanted defibrillators and/or resynchronization devices). At their first visit, we assessed levels of brain natriuretic peptide (BNP) (pg/mL), evaluated transthoracic conductance (TFC) (1/kΩ) by transthoracic bioimpedance, and performed echocardiography.
  
  
  RESULTS
  Four-year mortality was 21.2%. At multivariate analysis, surviving and deceased subjects did not differ regarding New York Heart Association, age, gender, heart failure etiology, or EF at index visit. Patients who died had higher BNP and TFC (BNP = 884 ± 119 pg/mL vs 334 ± 110 pg/mL; TFC = 50 ± 8/kΩ vs 37 ± 7/kΩ, both P < 0.001]. Patients with BNP < 450 pg/mL and TFC < 40/kΩ had a 2.1% 4-year mortality, compared to 46.5% mortality of patients having BNP ≥ 450 pg/mL and TFC ≥ 40/kΩ. BNP ≥ 450 pg/mL and TFC ≥ 40/kΩ showed high sensitivity (91%) and specificity (88%)in identifying patients who died at follow-up.
  
  
  CONCLUSIONS
  The combined use of BNP and impedance cardiography during the first assessment of a patient in a heart failure unit identified those carrying a worse medium-term prognosis. This approach could help the subsequent management of patients, allowing better clinical and therapeutic strategies.
authors: Cardiology Division, Saint Luke Hospital, Italian Auxologic Institute IRCCS, Milan, Italy. malfi@auxologico.it
authors: Gabriella
authors: G
authors: Malfatto
authors: Alfredo
authors: A
authors: Corticelli
authors: Alessandra
authors: A
authors: Villani
authors: Alessia
authors: A
authors: Giglio
authors: Francesco
authors: F
authors: Della Rosa
authors: Giovanna
authors: G
authors: Branzi
authors: Mario
authors: M
authors: Facchini
authors: Gianfranco
authors: G
authors: Parati
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D002307:Cardiography, Impedance; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
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