PMID- 17675058
OWN - NLM
STAT- MEDLINE
DCOM- 20070925
LR  - 20151119
IS  - 1532-8414 (Electronic)
IS  - 1071-9164 (Linking)
VI  - 13
IP  - 6
DP  - 2007 Aug
TI  - Multiparametric risk stratification in patients with mild to moderate chronic 
      heart failure.
PG  - 445-51
AB  - BACKGROUND: Whether brain natriuretic peptide (BNP) combined with cardiopulmonary 
      exercise test (CPx) and echocardiographic findings improves prognostic 
      stratification in mild-to-moderate systolic heart failure (HF) is unclear. 
      METHODS AND RESULTS: A total of 244 consecutive stable outpatients, median age of 
      71 (62-76) years, with New York Heart Association (NYHA) Class I-III HF and left 
      ventricular ejection fraction (LVEF) < 45% underwent BNP measurement, Doppler 
      echocardiography, and a maximal CPx. Median BNP was 166 (70-403) pg/mL, median 
      LVEF 35% (28%-40%). A restrictive filling pattern (RFP) was present in 44 
      patients (18%). At CPx, peak oxygen uptake was 12 (9.7, 14.4) mL/kg/min and an 
      enhanced ventilatory response to exercise (EVR, slope of the ventilation to CO2 
      production ratio, > or = 35) was found in 90 patients (37%) During 18 (9-37) 
      follow-up months, 80 patients died or were admitted for worsening HF (33%). In 
      addition to simple bedside clinical variables (NYHA Class III, creatinine 
      clearance, hemoglobin), BNP levels were predictive of outcome (HR 1.35 
      [1.12-1.63]). However, both RFP (HR 3.36 [2.09-5.41]) and a steeper minute 
      ventilation-carbon dioxide output slope (HR 1.50 [1.19-1.88]) outperformed BNP as 
      prognostic markers. Patients with both RFP and EVR had a 7.30 (95% CI 4.02-13.25) 
      HR for death or HF-admission versus subjects with neither predictor. CONCLUSIONS: 
      This study highlights the importance of a multiparametric approach for optimal 
      risk stratification in the elderly with mild-to-moderate HF. Patients at high 
      risk should undergo closer follow-up and be carefully evaluated for different 
      therapeutic options, including nonpharmacologic treatment.
FAU - Scardovi, Angela Beatrice
AU  - Scardovi AB
AD  - Department of Cardiology, S. Spirito Hospital, Rome, Italy.
FAU - De Maria, Renata
AU  - De Maria R
FAU - Coletta, Claudio
AU  - Coletta C
FAU - Aspromonte, Nadia
AU  - Aspromonte N
FAU - Perna, Silvia
AU  - Perna S
FAU - Cacciatore, Giuseppe
AU  - Cacciatore G
FAU - Parolini, Marina
AU  - Parolini M
FAU - Ricci, Roberto
AU  - Ricci R
FAU - Ceci, Vincenzo
AU  - Ceci V
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
RN  - 0 (Biomarkers)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 142M471B3J (Carbon Dioxide)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Aged
MH  - Biomarkers/blood
MH  - Breath Tests
MH  - Carbon Dioxide/metabolism
MH  - Disease Progression
MH  - Echocardiography, Doppler
MH  - Exercise Test
MH  - Female
MH  - Fluoroimmunoassay
MH  - Follow-Up Studies
MH  - Heart Failure/blood/*diagnosis/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*blood
MH  - Outpatients
MH  - Oxygen/metabolism
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Stroke Volume/*physiology
EDAT- 2007/08/07 09:00
MHDA- 2007/09/26 09:00
CRDT- 2007/08/07 09:00
PHST- 2006/10/21 00:00 [received]
PHST- 2007/02/05 00:00 [revised]
PHST- 2007/03/06 00:00 [accepted]
PHST- 2007/08/07 09:00 [pubmed]
PHST- 2007/09/26 09:00 [medline]
PHST- 2007/08/07 09:00 [entrez]
AID - S1071-9164(07)00075-9 [pii]
AID - 10.1016/j.cardfail.2007.03.003 [doi]
PST - ppublish
SO  - J Card Fail. 2007 Aug;13(6):445-51. doi: 10.1016/j.cardfail.2007.03.003.