Elsevier

Journal of Cardiac Failure

Volume 11, Issue 7, September 2005, Pages 498-503
Journal of Cardiac Failure

Clinical Investigation
B-Type Natriuretic Peptide Can Predict the Medium-Term Risk in Patients With Acute Heart Failure and Preserved Systolic Function

https://doi.org/10.1016/j.cardfail.2005.05.002Get rights and content

Abstract

Background

Half of patients with heart failure (HF) have preserved left ventricular ejection fraction (LVEF). Neurohormonal activation characterizes the disease and measurement of plasma B-type natriuretic peptide (BNP) indicates the severity of left ventricular dysfunction. The purpose of this study was to test the hypothesis that measurement of BNP levels in ambulatory patients with HF and preserved LVEF can predict the occurrence of cardiovascular events in the next 6 months.

Methods and Results

We enrolled 233 consecutive patients admitted to the Outpatient Heart Failure Clinic (OHFC), on stabilization after an episode of acute HF, with a LVEF >50%. Standard echocardiography was performed and left ventricular systolic/diastolic function was assessed. Plasma BNP levels were measured on admission to OHFC. Patients were followed for 6 months; the main endpoint combined cardiovascular death or readmission for HF. Among the 233 patients discharged, 48 endpoints occurred (death: n = 15; readmission: n = 33). Receiver operated curve analysis shows that BNP levels are strong predictors of subsequent events (area under the curve = 0.84; CI = 0.78–0.88). Multivariate Cox regression showed that the cutoff values identified by receiver operated curve analysis (200–500 pg/mL) of the neurohormone are the most accurate predictors of events: HR = 2.2 (P < .04) and HR = 5.8 (P < .001), respectively, for 201–499 pg/mL and ≥500 pg/mL ranges.

Conclusion

BNP level is a strong predictor for cardiovascular mortality and early readmission in patients with diastolic HF. The results suggest that BNP levels might be used successfully to guide the intensity of follow-up after a decompensation, because increased BNP levels were associated with a progressively bad prognosis.

Section snippets

Patients

During the study period, all patients who were admitted to the Outpatient Heart Failure Unit (OHFC) for acute HF were screened for the study. To be eligible for the latter, patients had to simultaneously meet the following inclusion criteria:

  • 1.

    symptoms of HF, according to the criteria commonly accepted in the literature,17 namely the presence of 2 major criteria or 1 major criterion + 2 minor criteria according to the Framingham score;

  • 2.

    New York Heart Association (NYHA) functional class II, III, or

Study Design

This is a prospective cohort study approved by local ethics committees.

Baseline Characteristics of Population

Table 1 summarizes the baseline characteristics of the population at study entry. They were elderly patients (age 76 ± 11 years), mainly females (58%), who suffered from numerous cardiovascular comorbidities, especially hypertension (59%), ischemic heart disease (38%), atrial fibrillation (31%), diabetes mellitus (23%), and chronic obstructive pulmonary disease (22%). This distribution is similar to the epidemiologic data relating to the general population hospitalized for HF.27 This also

Prognostic Stratification of Patients Discharged With a Diagnosis of Diastolic HF

Diastolic HF is a disorder with a growing epidemiologic impact characterized by frequent episodes of decompensation, which often require hospitalisation.3 In our study, patients a low event rate was observed in during the 6-month follow-up period, probably from both to the inclusion of patients with mild decompensation (43% of patients had mild diastolic dysfunction) and to a postdischarge active follow-up program, which has been widely reported decreasing event rate.34 Studies conducted on

Acknowledgments

We wish to thank Maura Chinellato (Basic Health Services Department, San Donà di Piave). Two anonymous referees improved an earlier version of the manuscript.

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