N-terminal protype-B natriuretic peptide and Doppler diastolic variables are incremental for risk stratification of patients with NYHA class I–II systolic heart failure

• Published in: International journal of cardiology 2009-08, Vol.136 (2), p.144-150
• Main Authors: Dini, Frank Lloyd, Fontanive, Paolo, Buralli, Simona, Panicucci, Erica, Andreini, Diana, Conti, Umberto, De Tommasi, Salvatore Mario
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Diastole; Diastolic dysfunction; Early Diagnosis; Echocardiography; Echocardiography, Doppler; Female; Follow-Up Studies; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Systolic - blood; Heart Failure, Systolic - diagnostic imaging; Heart Failure, Systolic - mortality; Hospitalization - statistics & numerical data; Humans; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Natriuretic Peptide, Brain - blood; Natriuretic peptides; Peptide Fragments - blood; Predictive Value of Tests; Prognosis; Risk Factors; Systole; Ultrasonic investigative techniques
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2008.04.032

Abstract Background In systolic heart failure (HF), preventing the development of severe symptoms, before patients are in advanced NYHA functional classes, is a worthwhile target of therapy. Early recognition of left ventricular (LV) diastolic dysfunction and neuroendocrine activation may have an important impact on patient's outcome. Aim To investigate whether N-terminal proBNP (NT-proBNP) and mitral flow and tissue Doppler (TD) diastolic parameters are incremental for risk stratification of systolic HF patients in NYHA class I and II. Methods The study consisted of 232 consecutive outpatients with systolic HF (ejection fraction [EF] ≤ 45%) in NYHA class I to II. They had a full Doppler two-dimensional-echocardiographic study, including pulsed-Doppler mitral E wave deceleration time (EDT) and TD early septal annular velocity ( E ′). Plasma NT-proBNP was assessed at the time of the echocardiogram. Results During a median follow-up of 31 months, there were 65 events (25 deaths and 40 HF-related hospitalizations). Multivariate analysis showed that N-terminal proBNP > 544 pg/ml (hazards ratio [HR]: 2.66; p = 0.012), EF < 37% (HR: 2.45; p = 0.006), E ≤ 8 cm/s (HR: 1.84; p = 0.045) and EDT < 150 ms (HR: 1.78; p = 0.026) significantly correlated with events. On forward stepwise analysis, EDT ( p < 0.0001) and E ′ ( p < 0.0001) provided an incremental contribution to the outcome prediction above and beyond conventional risk markers, that was further increased by the addition of NT-proBNP ( p < 0.0001). Conclusion In patients with systolic HF in NYHA functional class I and II, N-terminal proBNP and LV mitral flow and TD variables of diastolic dysfunction had a strong predictive power for the combined end point of all-cause mortality and HF-related hospitalizations.