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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Plasma N-terminal protype-B natriuretic peptide and restrictive mitral flow to risk-stratify patients with stage B

Frank L Dini1, Gillian Whalley, Katrina Poppe

  • 1Cardiovascular Diseases Unit 2, Santa Chiara Hospital, Pisa, Italy.

Clinical Cardiology
|December 23, 2009
PubMed

Insights

Plasma NT-proBNP and echocardiography (EDT, EF) effectively stratify risk in asymptomatic stage B heart failure patients, with combined measures offering incremental prognostic value for cardiac events.

Area of Science:

  • Cardiology
  • Biomarkers
  • Diagnostic Imaging

Background:

  • Prognostic role of echocardiography is established in symptomatic heart failure (HF).
  • Limited understanding of risk stratification in stage B HF (structural heart disease, no symptoms).
  • Investigating NT-proBNP and Doppler-echo parameters for stage B HF risk assessment.

Purpose of the Study:

  • To determine if plasma NT-proBNP and Doppler-echo parameters (diastolic and systolic function) can stratify risk in stage B HF patients.
  • To assess the independent and combined prognostic utility of these markers.

Main Methods:

  • 155 outpatients with asymptomatic LV dysfunction (EF < 50%) underwent Doppler echocardiography.
  • Assessed conventional diastolic variables including E-wave deceleration time (EDT).
  • Measured plasma NT-proBNP; end point was cardiac death or HF hospitalization/medication change.

Main Results:

  • Mean EF was 35%. Median NT-proBNP was 745 pg/mL.
  • Plasma NT-proBNP, EDT, and EF were independently associated with cardiac events.
  • Optimal cut points identified: NT-proBNP ≥ 831 pg/mL, EDT < 145 msec, EF < 37%.

Conclusions:

  • Plasma NT-proBNP, EDT, and EF are valuable for prognostic stratification in stage B HF.
  • Combined abnormalities showed incrementally worse event-free survival.
  • Supports complementary use of echocardiography and natriuretic peptide assays in asymptomatic LV dysfunction.
Abstract

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