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Multiparametric risk stratification in patients with mild to moderate chronic heart failure

Angela Beatrice Scardovi1, Renata De Maria, Claudio Coletta

  • 1Department of Cardiology, S. Spirito Hospital, Rome, Italy.

Journal of Cardiac Failure
|August 7, 2007
PubMed

Insights

Combining cardiopulmonary exercise tests and echocardiography offers superior risk prediction in heart failure patients compared to brain natriuretic peptide alone. These multiparametric approaches improve prognostic stratification for better patient management.

Area of Science:

  • Cardiology
  • Pulmonology
  • Geriatrics

Background:

  • Prognostic stratification in mild-to-moderate systolic heart failure (HF) remains challenging.
  • The combined utility of brain natriuretic peptide (BNP), cardiopulmonary exercise testing (CPx), and echocardiography is not fully understood.

Purpose of the Study:

  • To evaluate the prognostic value of BNP, CPx-derived parameters, and echocardiographic findings in predicting outcomes in patients with mild-to-moderate systolic HF.
  • To determine if a multiparametric approach improves risk stratification compared to individual markers.

Main Methods:

  • A cohort of 244 stable outpatients with NYHA Class I-III HF and LVEF < 45% underwent BNP measurement, Doppler echocardiography, and maximal CPx.
  • Follow-up for 18 months assessed all-cause mortality or HF re-hospitalization.
  • Statistical analysis included Cox proportional hazards models to identify independent predictors.

Main Results:

  • BNP levels, NYHA Class III, creatinine clearance, and hemoglobin predicted outcomes.
  • Restrictive filling pattern (RFP) on echocardiography (HR 3.36) and enhanced ventilatory response to exercise (EVR, HR 1.50) outperformed BNP (HR 1.35) as prognostic markers.
  • Patients with both RFP and EVR had a significantly higher risk (HR 7.30) of death or HF admission.

Conclusions:

  • A multiparametric approach integrating echocardiography and CPx is crucial for optimal risk stratification in elderly patients with mild-to-moderate HF.
  • High-risk patients identified by these methods require closer monitoring and tailored therapeutic strategies, including non-pharmacologic options.
Abstract

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