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Combination of B-type natriuretic peptide and peak oxygen consumption improves risk stratification in outpatients with chronic heart failure.
Am Heart J. 2003 Oct; 146(4):729-35.AH

Abstract

BACKGROUND

Peak oxygen consumption is a cornerstone for prognostic determination in patients with congestive heart failure. The purpose of this study was to assess whether plasma B-type natriuretic peptide (BNP) provided any additional prognostic information.

METHODS

Plasma concentrations of atrial natriuretic peptide, N terminal pro-atrial natriuretic peptide, BNP, endothelin-1, norepinephrine, and peak VO2 were measured in 250 consecutive outpatients with mild to moderate heart failure (96% in New York Heart Association [NYHA] class II or III) and left ventricular ejection fraction (LVEF) <45%.

RESULTS

During a median follow-up of 584 days, 42 patients died (19 from sudden death) and 5 underwent urgent heart transplantation. Multivariate stepwise regression analysis showed that, among 13 variables including NYHA and LVEF, plasma BNP (chi2 = 11.9, P =.0001) was the strongest independent predictor of death or urgent transplantation, followed by serum sodium (chi2 = 8, P =.0046), resting heart rate (chi2 = 7.5, P =.0062), plasma endothelin-1 (chi2 = 7.2, P =.007), and peak VO2 (chi2 = 6.2, P =.012). Patients with plasma BNP above the upper quartile value (260 pg/mL) had a 1-year rate of death or urgent transplantation of 31%. The 1- and 2-year survival rates without urgent transplantation in patients with a peak VO2 < or =14 mL x kg(-1) x min(-1) were 71% and 59%, respectively, when plasma BNP was >137 pg/mL (median value), compared with 100% and 89%, respectively, when plasma BNP was < or =137 pg/mL (P =.008). Furthermore, plasma BNP was the only independent predictor of sudden death (chi2 = 19.9, P =.00001).

CONCLUSIONS

Plasma BNP provides additive independent prognostic information compared to peak VO2 alone in outpatients with mild to moderate heart failure.

Authors+Show Affiliations

Service de Cardiologie, Institut Fédératif de Recherche 14 Heart, vessels, muscle UPRES EA 2390, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France. richard.isnard@psl.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14564330

Citation

Isnard, Richard, et al. "Combination of B-type Natriuretic Peptide and Peak Oxygen Consumption Improves Risk Stratification in Outpatients With Chronic Heart Failure." American Heart Journal, vol. 146, no. 4, 2003, pp. 729-35.
Isnard R, Pousset F, Chafirovskaïa O, et al. Combination of B-type natriuretic peptide and peak oxygen consumption improves risk stratification in outpatients with chronic heart failure. Am Heart J. 2003;146(4):729-35.
Isnard, R., Pousset, F., Chafirovskaïa, O., Carayon, A., Hulot, J. S., Thomas, D., & Komajda, M. (2003). Combination of B-type natriuretic peptide and peak oxygen consumption improves risk stratification in outpatients with chronic heart failure. American Heart Journal, 146(4), 729-35.
Isnard R, et al. Combination of B-type Natriuretic Peptide and Peak Oxygen Consumption Improves Risk Stratification in Outpatients With Chronic Heart Failure. Am Heart J. 2003;146(4):729-35. PubMed PMID: 14564330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination of B-type natriuretic peptide and peak oxygen consumption improves risk stratification in outpatients with chronic heart failure. AU - Isnard,Richard, AU - Pousset,Françoise, AU - Chafirovskaïa,Olga, AU - Carayon,Alain, AU - Hulot,Jean Sébastien, AU - Thomas,Daniel, AU - Komajda,Michel, PY - 2003/10/18/pubmed PY - 2003/11/5/medline PY - 2003/10/18/entrez SP - 729 EP - 35 JF - American heart journal JO - Am. Heart J. VL - 146 IS - 4 N2 - BACKGROUND: Peak oxygen consumption is a cornerstone for prognostic determination in patients with congestive heart failure. The purpose of this study was to assess whether plasma B-type natriuretic peptide (BNP) provided any additional prognostic information. METHODS: Plasma concentrations of atrial natriuretic peptide, N terminal pro-atrial natriuretic peptide, BNP, endothelin-1, norepinephrine, and peak VO2 were measured in 250 consecutive outpatients with mild to moderate heart failure (96% in New York Heart Association [NYHA] class II or III) and left ventricular ejection fraction (LVEF) <45%. RESULTS: During a median follow-up of 584 days, 42 patients died (19 from sudden death) and 5 underwent urgent heart transplantation. Multivariate stepwise regression analysis showed that, among 13 variables including NYHA and LVEF, plasma BNP (chi2 = 11.9, P =.0001) was the strongest independent predictor of death or urgent transplantation, followed by serum sodium (chi2 = 8, P =.0046), resting heart rate (chi2 = 7.5, P =.0062), plasma endothelin-1 (chi2 = 7.2, P =.007), and peak VO2 (chi2 = 6.2, P =.012). Patients with plasma BNP above the upper quartile value (260 pg/mL) had a 1-year rate of death or urgent transplantation of 31%. The 1- and 2-year survival rates without urgent transplantation in patients with a peak VO2 < or =14 mL x kg(-1) x min(-1) were 71% and 59%, respectively, when plasma BNP was >137 pg/mL (median value), compared with 100% and 89%, respectively, when plasma BNP was < or =137 pg/mL (P =.008). Furthermore, plasma BNP was the only independent predictor of sudden death (chi2 = 19.9, P =.00001). CONCLUSIONS: Plasma BNP provides additive independent prognostic information compared to peak VO2 alone in outpatients with mild to moderate heart failure. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/14564330/Combination_of_B_type_natriuretic_peptide_and_peak_oxygen_consumption_improves_risk_stratification_in_outpatients_with_chronic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000287030300365X DB - PRIME DP - Unbound Medicine ER -