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

Frank Lloyd Dini, Paolo Fontanive, Simona Buralli, Erica Panicucci, Diana Andreini, Umberto Conti, Salvatore Mario De Tommasi
International Journal of Cardiology 2009 August 14, 136 (2): 144-50

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] <or=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 <or=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.

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