Similar predictive value of six-minute walking distance and B-type natriuretic peptide in heart failure with reduced...

Area of Science:

• Cardiology
• Heart Failure Research
• Clinical Prognostics

Background:

• Prognostic value of heart failure with mid-range ejection fraction (HFmrEF) remains unclear.
• Existing prognostic tools may not fully capture risk across the spectrum of left ventricular (LV) systolic dysfunction.
• Understanding risk stratification in HFmrEF compared to heart failure with reduced ejection fraction (HFrEF) is crucial.

Purpose of the Study:

• To evaluate the predictive power of the six-minutes walking test (6MWT) and brain natriuretic peptide (BNP) for outcomes in heart failure (HF) patients.
• To determine if the HFmrEF classification impacts the risk stratification abilities of 6MWT and BNP.
• To assess prognostic value across the full spectrum of LV systolic dysfunction.

Main Methods:

• Study included 538 outpatients with stable chronic HF and LV ejection fraction (LVEF) <50%, categorized into HFmrEF (n=349) and HFrEF (n=189).
• Utilized 6MWT distance and plasma BNP levels as prognostic markers.
• Follow-up for all-cause and cardiac death over a median of 32 months, with multivariable analysis adjusting for clinical factors.

Main Results:

• Both BNP (cut-off 125 pg/ml) and 6MWT (cut-off 360 meters) independently predicted all-cause and cardiac mortality.
• These markers retained prognostic value across LVEF strata, outperforming the 40% LVEF threshold.
• Higher BNP and shorter 6MWT distance combined identified a high-risk subgroup (26%) in both HFmrEF and HFrEF populations.

Conclusions:

• BNP levels and 6MWT distance are robust independent predictors of outcome in patients with chronic HF, irrespective of LVEF.
• These functional and biomarker assessments provide significant prognostic information across the spectrum of LV systolic dysfunction.
• The HFmrEF classification does not diminish the established prognostic utility of BNP and 6MWT.