کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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2962499 | 1178433 | 2007 | 7 صفحه PDF | دانلود رایگان |
BackgroundWhether 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 ResultsA 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, ≥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.ConclusionsThis 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.
Journal: Journal of Cardiac Failure - Volume 13, Issue 6, August 2007, Pages 445–451