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Hibernating myocardium: high or low risk?
  1. J H McGowan
  1. Correspondence to:
    Dr James H McGowan
    Cardiothoracic Unit, James Cook University Hospital, Middlesbrough TS5 3BW, UK;

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The optimal strategy for risk stratification in heart failure continues to evolve, with increasing numbers of tools such as natriuretic peptide assessment being utilised

The assessment of risk, and its subsequent manipulation, accounts for a large amount of what we do in cardiology. Among the heart failure population, increasing numbers of tools are being utilised for the purpose. In this issue of Heart, Schinkel and colleagues1 present data on the combined use of both physiological and biochemical markers of risk in heart failure.

Many studies have shown that, as a screening test, a low concentration of natriuretic peptide in patients with suspected heart failure has a high negative predictive value.2 Furthermore, in patients with the diagnosis, variation in natriuretic peptide concentration may predict subsequent hospitalisation and death.3,4

The study by Schinkel and colleagues1 found that natriuretic peptide values were substantially lower in patients without heart failure, which is entirely consistent with previous findings. The investigators then examined contractile reserve in …

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