title: Prognostic stratification of patients with chronic systolic heart failure using biomarkers and Doppler echocardiography.
abstract: OBJECTIVE
  To verify whether a combined assessment of left-ventricular filling pattern at Doppler echocardiography, plasma levels of brain natriuretic peptide (BNP) and high-sensitive troponin I (hsTnI) improves prognostic stratification in patients with chronic systolic heart failure.
  
  
  METHODS
  Three predictors of prognosis were evaluated in 200 consecutive outpatients with heart failure and left-ventricular ejection fraction 35% or less: left-ventricular filling pattern at Doppler echocardiography, BNP plasma levels and hsTnI plasma levels.
  
  
  RESULTS
  During a median follow-up period of 44 months, 15 deaths, two urgent cardiac transplantations, two episodes of ventricular fibrillation and 50 heart failure hospitalizations were observed. The end point of survival analysis was the composite of hard events and hospitalization for acute heart failure. At univariable analysis, the E-wave deceleration time at Doppler echocardiography and BNP plasma level on a continuous log-scale were significantly associated with event-free survival, whereas hsTnI plasma level was not statistically significant. A hierarchical multivariable analysis was performed including a restrictive left-ventricular filling pattern at Doppler as the first prognostic indicator; the subsequent addition of BNP plasma levels above 138  pg/ml (median value) and hsTnI above 0.018  ng/ml (median value) did not further improve prognostic stratification.
  
  
  CONCLUSIONS
  A restrictive left-ventricular filling pattern at Doppler echocardiography is the most important prognostic indicator in chronic heart failure patients. Plasma levels of BNP and hsTnI do not provide additional relevant information to identify patients at higher risk of cardiovascular outcomes.
authors.affiliation: aDivisione di Cardiologia bServizio di Analisi Chimico Cliniche cDipartimento di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Alessandrino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Albertini
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Bruna
authors.initials: B
authors.lastname: Girardi
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Maggi
authors.forename: Anna Sara
authors.initials: AS
authors.lastname: Pazzano
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.forename: Laura
authors.initials: L
authors.lastname: Scelsi
authors.forename: Luigi Oltrona
authors.initials: LO
authors.lastname: Visconti
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain