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[Peak oxygen consumption, NT-proBNP and echocardiographic changes in patients with chronic heart failure]
Zhinan Lu1, Xingguo Sun2, Shengshou Hu1
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Peak oxygen consumption (peak VO₂) is a more sensitive indicator of worsening chronic heart failure (CHF) than NT-proBNP or echocardiography. This finding aids in identifying advanced disease stages in CHF patients with reduced ejection fraction.
Area of Science:
- Cardiology
- Exercise Physiology
- Biomarkers
Background:
- Chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) significantly impacts patient prognosis.
- Accurate assessment of disease severity is crucial for effective management.
- Current assessment tools include cardiopulmonary exercise testing (CPET), NT-proBNP levels, and echocardiography.
Purpose of the Study:
- To compare the utility of peak oxygen consumption (peak VO₂), NT-proBNP concentrations, and echocardiographic parameters in assessing disease severity in CHF patients.
- To determine which parameter best discriminates between NYHA functional classes II and III-IV.
Main Methods:
- Seventy CHF patients with LVEF <40% were divided into NYHA II (17) and NYHA III-IV (53) groups.
- Peak VO₂ from CPET, resting NT-proBNP, and echocardiographic parameters (LA, LVEDD, LVEF) were measured and compared.
- Correlation and receiver operating characteristic (ROC) curve analyses were performed.
Main Results:
- NYHA III-IV patients exhibited significantly larger left atrial diameter, higher NT-proBNP, and lower peak VO₂ compared to NYHA II patients.
- Peak VO₂ showed a significant negative correlation with NT-proBNP but not with echocardiographic parameters.
- ROC analysis revealed peak VO₂ as the strongest discriminator for NYHA III-IV (AUC=0.835), followed by NT-proBNP (AUC=0.723).
Conclusions:
- Peak VO₂ is a more sensitive marker than NT-proBNP and echocardiographic parameters for detecting disease aggravation in CHF patients with reduced LVEF.
- Cardiopulmonary exercise testing provides valuable prognostic information in this patient population.
Objective:
To assess peak oxygen consumption (peak VO₂) derived from cardiopulmonary exercise testing (CPET), concentrations of NT-proBNP and echocardiographic changes in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF, <40%).
Methods:
Seventy patients were included and divided into two groups according to the New York Heart Association (NYHA) classification: NYHA II group (17 cases) and NYHA III-IV group (53 cases). The basic clinical information, plasma concentration of NT-proBNP at rest, echocardiographic parameters and peak VO₂from CPET were compared between two groups. Correlation among peak VO₂, NT-proBNP and echocardiographic parameters in this patient cohort was assessed and their abilities to discriminate the NYHA III-IV grade were analyzed through c-Statistic.
Results:
Left atrial diameter ((51.3 ± 7.2) mm vs. (44.0±7.4) mm, P<0.001) was larger, plasma concentration of NT-proBNP (1 379-4 399 pmol/L vs. 1 109-2 356 pmol/L, P<0.01) was higher and peak VO₂((13.4 ± 3.5) ml·kg⁻¹·min⁻¹ vs. (18.2 ± 3.7) ml·kg⁻¹·min⁻¹, P<0.001) were significantly lower in NYHA III-IV group than those in NYHA II group. However, left ventricular end-diastolic diameter (LVEDD) and LVEF were similar between two groups. Peak VO₂correlated significantly with NT-proBNP (r=-0.311, P<0.01), but neither peak VO₂nor NT-proBNP correlated with echocardiographic parameters (LA, LVEDD and LVEF). ROC analysis showed that peak VO₂had the strongest discriminatory power for detecting NYHA III-IV grade patients (AUC=0.835, P<0.001), followed by the NT-proBNP (AUC=0.723, P<0.01).
Conclusion:
Peak VO₂is a more sensitive parameter to detect the disease aggravation (NYHA III-IV grade) of the CHF patients with reduced LVEF compared to plasma NT-proBNP and echocardiographic parameters (LA, LVEDD, LVEF).
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