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CLINICAL RESEARCH: BNP AND HEART FAILURE

B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure

Pascal de Groote, MD^*,*, Joël Dagorn, MD^*, Benoit Soudan, MD, Nicolas Lamblin, MD^*, Eugene McFadden, FRCPI, FACC and Christophe Bauters, MD, FACC^*

^* Service de Cardiologie C, Hôpital Cardiologique, Lille Cedex, France
Laboratoire d'endocrinologie, Clinique Linquette, CHRU, 59037 Lille Cedex, France
Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands

Manuscript received October 13, 2003; accepted November 12, 2003.

^* Reprint requests and correspondence: Dr. Pascal de Groote, Service de cardiologie C, Hôpital cardiologique, Boul Prof J. Leclercq, CHRU de Lille, 59037 Lille Cedex, France.
pdegroote{at}chru-lille.fr

OBJECTIVES: The aim of this study was to compare the prognostic value of peak oxygen consumption (VO₂) and B-type natriuretic peptide (BNP) in patients with stable congestive heart failure (CHF).

BACKGROUND: Previous studies have demonstrated that both peak VO₂ and BNP are useful for risk stratification in patients with CHF. No study has compared the respective prognostic value of these two parameters in a large series of patients receiving a combination of angiotensin-converting enzyme inhibitors and of beta-blockers.

METHODS: Patients with stable CHF underwent radionuclide angiography, echocardiography, 24-h Holter monitoring, and a cardiopulmonary exercise test. Blood samples were drawn for standard measurements and for hormonal determinations.

RESULTS: After a median follow-up period of 787 days, there were 75 cardiac-related deaths and three urgent transplantations. Independent predictors of cardiac survival were percent of maximal predicted VO₂ (%VO₂, relative risk [RR] = 2.84 [95% confidence interval, CI = 1.73 to 4.65], p < 0.00001), BNP (RR = 3.17 [95% CI 1.68 to 5.96], p = 0.0004), left atrial diameter (LAD) (RR = 2.04 [95% CI 1.25 to 3.34], p = 0.004), age (RR = 1.93 [95% CI 1.22 to 3.05], p = 0.005), and aldosterone (RR = 1.84 [95% CI 1.12 to 3.00], p = 0.015). In patients with infra-median levels of BNP (<109 pg/ml), age was the only independent predictor of cardiac survival. However, in patients with supra-median levels of BNP, independent predictors of cardiac survival were %VO₂ (RR = 3.76 [95% CI 2.19 to 6.45], p < 0.00001) and LAD (RR = 1.90 [95% CI 1.10 to 3.28], p = 0.02).

CONCLUSIONS: B-type natriuretic peptide, in combination with %VO₂, improves risk stratification of patients with stable CHF.

Abbreviations and Acronyms   ACE-I = angiotensin-converting enzyme inhibitors   BNP = B-type natriuretic peptide   CHF = congestive heart failure   CI = confidence interval   LAD = left atrial diameter   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   RR = relative risk   UNOS = United Network for Organ Sharing   VO2 = peak oxygen consumption   %VO2 = percent maximal predicted VO2

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