Combination of B-type natriuretic peptide and minute ventilation/carbon dioxide production slope improves risk stratification in patients with diastolic heart failure

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• 作者：Jing Yan ; ^{yanjing2011@yahoo.com.cn} ; Shi-Jin Gong ; Li Li ; Hai-Yan Yu ; Hai-Wen Dai ; Jin Chen ; Cheng-Wu Tan ; Qiang-Hong Xv ; Guo-Long Cai
• 关键词：Diastolic heart failure ; B-type natriuretic peptide ; Exercise testing ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：20 January, 2013
• 年：2013
• 卷：162
• 期：3
• 页码：193-198
• 全文大小：344 K

文摘

Background

Recent studies demonstrated that the minute ventilation/carbon dioxide production (VE/VCO₂) slope more powerfully predicted mortality, hospitalization, or both than peak oxygen consumption (VO₂) in systolic heart failure. However, the prognostic values of these two parameters in diastolic heart failure remained unclear.

Methods

The patients with diastolic heart failure were recruited from April 2006 to May 2007, and underwent cardiopulmonary exercise testing. Plasma BNP concentration was measured using Triage BNP immunoassay method.

Results

Of the 224 patients enrolled, mean values for age and New York Heart Association (NYHA) class were 68.8 ¡À 9.0 years and 2.38 ¡À 0.53, respectively. During the mean follow-up of 30 months, 57 patients died (36 from cardiovascular death). Univariate Cox regression analysis showed that age, NYHA class, atrial fibrillation, diabetes mellitus, left ventricular diastolic dysfunction, peak VO₂, VE/VCO₂ slope, and plasma BNP were significantly associated with mortality. Multivariate analysis revealed that plasma BNP, VE/VCO₂ slope, and age remained independent predictors for cardiovascular and all-cause mortalities, with the strongest prognostic power of plasma BNP (¦Ö² ¡Ý 31.4, P < 0.001). In addition to plasma BNP and clinical predictors, the VE/VCO₂ slope could provide independent and incremental prognostic value of cardiovascular (¦Ö² = 60.6 vs 51.7; P = 0.009) and all-cause mortalities (¦Ö² = 62.8 vs 54.2; P = 0.015) with increased ¦Ö² value of Cox regression model.

Conclusion

In diastolic heart failure, plasma BNP is the strongest predictor of mortality, and VE/VCO₂ slope provides independent and additive prognostic information, which suggests that combination of plasma BNP and VE/VCO₂ slope can improve risk stratification.