Related Experiment Video
Updated: Dec 1, 2025
Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Prognostic value of natriuretic peptides and restrictive filling pattern before surgical ventricular restoration
Anna Toso1, Serenella Castelvecchio2, Lorenzo Menicanti2
1Division of Cardiology, Santo Stefano Hospital, Prato, Italy.
Insights
Combining elevated natriuretic peptide levels and a restrictive filling pattern (RFP) significantly improves risk prediction for patients with ischemic cardiomyopathy undergoing surgical ventricular restoration, identifying those at highest risk.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomarkers
Background:
- Increased natriuretic peptide levels and restrictive filling pattern (RFP) are known risk predictors in heart failure.
- Prognostic stratification in ischemic cardiomyopathy post-surgical ventricular restoration (SVR) requires refined methods.
Purpose of the Study:
- To evaluate the combined prognostic value of natriuretic peptide levels and RFP in patients with ischemic cardiomyopathy undergoing SVR.
- To assess if combined markers improve risk stratification compared to individual markers.
Main Methods:
- 186 patients undergoing SVR had baseline echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) assays.
- Patients were grouped by NT-proBNP levels (upper tertile vs. lower) and RFP (E/A ratio ≥2).
- 36-month follow-up analyzed all-cause death or heart failure hospitalizations.
Main Results:
- High NT-proBNP and RFP, individually, were significant predictors of adverse outcomes (P < .0001).
- The combination of high NT-proBNP and RFP showed the highest adjusted hazard for adverse events (HR, 3.63; P < .0001).
- Distinct clinical and structural patterns were observed across the four groups.
Conclusions:
- Simultaneous use of NT-proBNP and RFP offers enhanced prognostic stratification for patients with ischemic cardiomyopathy undergoing SVR.
- This combined approach aids in characterizing distinct patient phenotypes and guiding treatment decisions.
Objective:
Both increased natriuretic peptide levels and restrictive filling pattern (RFP) are important risk predictors in patients with heart failure. The aim of this study was to examine the role of the combined use of natriuretic peptide and RFP for the prognostic stratification of patients with ischemic cardiomyopathy undergoing surgical ventricular restoration in the Biomarker Plus study.
Methods:
A total of 186 patients (aged 64 ± 10 years) underwent echocardiographic study and N-terminal pro-B-type natriuretic peptide assay at baseline (before surgical ventricular restoration). Patients were divided into 4 groups depending on baseline diastolic filling pattern (RFP/no RFP) and N-terminal pro-B-type natriuretic peptide level (less than or greater than or equal to the upper tertile value of 2003 ŋg/L). RFP was defined as E/A ratio ≥2. All-cause death or heart failure hospitalizations within 36-month follow-up were analyzed.
Results:
Despite similar ejection fraction, volumes, and mass, the 4 groups presented distinct clinical and structural pattern of presurgical ventricular restoration ventricular remodeling and significantly different clinical outcome after surgical unloading. During follow-up, 67 patients died or were hospitalized for heart failure (36%). High N-terminal pro-B-type natriuretic peptide levels and RFP, considered individually, were significantly associated with outcome (P < .0001). The combination of both was associated with the highest adjusted hazard of adverse events (hazard ratio, 3.63; 95% CI, 1.73-7.6; P < .0001).
Conclusions:
The simultaneous use of 2 markers, 1 biological and 1 echocardiographic, may allow better prognostic stratification and characterization of the distinct structural and clinical phenotypes in a population of patients with ischemic cardiomyopathy undergoing surgical ventricular restoration. This approach could be useful in the decision-making process to guide treatment choices in patients with ischemic cardiomyopathy.
More Related Videos
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
07:41Induction and Phenotyping of Acute Right Heart Failure in a Large Animal Model of Chronic Thromboembolic Pulmonary Hypertension
Published on: March 17, 2022
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:22Heart Failure VI: Adjunct Therapies
01:22Heart Failure Drugs: Diuretics