This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (43) Citing Articles via Google Scholar Google Scholar Articles by Dokainish, H. Articles by Nagueh, S. F. Search for Related Content PubMed PubMed Citation Articles by Dokainish, H. Articles by Nagueh, S. F.

CLINICAL RESEARCH: PROGNOSTIC MARKERS IN HEART FAILURE

Incremental predictive power of B-type natriuretic peptide and tissue Doppler echocardiography in the prognosis of patients with congestive heart failure

Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.

Manuscript received October 28, 2004; revised manuscript received December 6, 2004, accepted January 4, 2005.

^_* Reprint requests and correspondence: Dr. Hisham Dokainish, Assistant Professor of Medicine-Cardiology, Baylor College of Medicine, 6550 Fannin, Suite 1901, Houston, Texas 77030. (Email: hishamd{at}bcm.tmc.edu).

OBJECTIVES: This study was designed to determine how novel indexes of left ventricular (LV) filling pressure—transmitral early diastolic velocity/tissue Doppler mitral annular early diastolic velocity (E/Ea) and B-type natriuretic peptide (BNP)—compare to conventional predictors of outcome in patients with congestive heart failure (CHF).

BACKGROUND: It is known that E/Ea can predict LV filling pressure in patients with cardiac disease, including, in contrast to conventional Doppler indexes, in normal ejection fraction. B-type natriuretic peptide has also been correlated to LV filling pressure, but appears to provide more global cardiac information than E/Ea. It is unknown, however, how these novel indexes compare to conventional predictors of CHF patient outcome.

METHODS: A total of 116 consecutive patients hospitalized with CHF underwent simultaneous clinical assessment, BNP, and comprehensive echo-Doppler study once ready for discharge. The ability of these variables to determine the primary end point (cardiac death or re-hospitalization for CHF) was determined.

RESULTS: Follow-up was complete on 110 of 116 patients at a mean of 527 days after hospital discharge. There were 54 patients (50%) with the primary end point (37 re-hospitalizations for CHF and 17 cardiac deaths). On Cox univariate analysis, E/Ea (chi-square = 13.6, p = 0.0001) and BNP (chi-square = 17.0, p < 0.0001) were significant predictors of the primary end point. In stepwise analysis, BNP 250 pg/ml and mitral E/Ea 15 had incremental predictive power (chi-square = 23.1, p for increment = 0.02), to which conventional predictors did not add further prognostic information.

CONCLUSIONS: In patients admitted to hospital with CHF, pre-discharge BNP and E/Ea are incremental predictors of outcome, to which conventional predictors do not significantly add.

Abbreviations and Acronyms   AUC = area under curve   BNP = B-type natriuretic peptide   CHF = congestive heart failure   DT = deceleration time   E/Ea = transmitral early diastolic velocity/tissue Doppler early diastolic annular velocity   EF = ejection fraction   LAVi = left atrial volume index   Ln = natural log   LV = left ventricular   TD = tissue Doppler

This article has been cited by other articles:

				N. S. Chahal, T. K. Lim, P. Jain, J. C. Chambers, J. S. Kooner, and R. Senior New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: a population study of hypertensive subjects Eur. Heart J., November 19, 2009; (2009) ehp490v1. [Abstract] [Full Text] [PDF]

				R. Mogelvang, P. Sogaard, S. A. Pedersen, N. T. Olsen, J. L. Marott, P. Schnohr, J. P. Goetze, and J. S. Jensen Cardiac Dysfunction Assessed by Echocardiographic Tissue Doppler Imaging Is an Independent Predictor of Mortality in the General Population Circulation, May 26, 2009; 119(20): 2679 - 2685. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, C. P. Appleton, T. C. Gillebert, P. N. Marino, J. K. Oh, O. A. Smiseth, A. D. Waggoner, F. A. Flachskampf, P. A. Pellikka, and A. Evangelisa Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography Eur J Echocardiogr, March 1, 2009; 10(2): 165 - 193. [Full Text] [PDF]

				R. W. Troughton and A. M. Richards B-type natriuretic peptides and echocardiographic measures of cardiac structure and function. J. Am. Coll. Cardiol. Img., February 1, 2009; 2(2): 216 - 225. [Abstract] [Full Text] [PDF]

				J. Mangat, C. Carter, G. Riley, Y. Foo, and M. Burch The clinical utility of brain natriuretic peptide in paediatric left ventricular failure Eur J Heart Fail, January 1, 2009; 11(1): 48 - 52. [Abstract] [Full Text] [PDF]

				S. N. Goonewardena, A. Gemignani, A. Ronan, S. Vasaiwala, J. Blair, J. M. Brennan, D. P. Shah, and K. T. Spencer Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic Peptide for predicting readmission after hospitalization for acute decompensated heart failure. J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 595 - 601. [Abstract] [Full Text] [PDF]

				A. Maisel, C. Mueller, K. Adams Jr., S. D. Anker, N. Aspromonte, J. G.F. Cleland, A. Cohen-Solal, U. Dahlstrom, A. DeMaria, S. Di Somma, et al. State of the art: Using natriuretic peptide levels in clinical practice Eur J Heart Fail, September 1, 2008; 10(9): 824 - 839. [Abstract] [Full Text] [PDF]

				G. A. Whalley, S. P. Wright, A. Pearl, G. D. Gamble, H. J. Walsh, M. Richards, and R. N. Doughty Prognostic role of echocardiography and brain natriuretic peptide in symptomatic breathless patients in the community Eur. Heart J., February 2, 2008; 29(4): 509 - 516. [Abstract] [Full Text] [PDF]

				L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]

				J. N. Kirkpatrick, M. A. Vannan, J. Narula, and R. M. Lang Echocardiography in Heart Failure: Applications, Utility, and New Horizons J. Am. Coll. Cardiol., July 31, 2007; 50(5): 381 - 396. [Abstract] [Full Text] [PDF]

				C.-M. Yu, J. E. Sanderson, T. H. Marwick, and J. K. Oh Tissue Doppler Imaging: A New Prognosticator for Cardiovascular Diseases J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1903 - 1914. [Abstract] [Full Text] [PDF]

				C-H Huang, M-S Tsai, C-C Hsieh, T-D Wang, W-T Chang, and W-J Chen Diagnostic accuracy of tissue Doppler echocardiography for patients with acute heart failure Heart, December 1, 2006; 92(12): 1790 - 1794. [Abstract] [Full Text] [PDF]

				J. F. Price, A. K. Thomas, M. Grenier, B. W. Eidem, E. O. Smith, S. W. Denfield, J. A. Towbin, and W. J. Dreyer B-Type Natriuretic Peptide Predicts Adverse Cardiovascular Events in Pediatric Outpatients With Chronic Left Ventricular Systolic Dysfunction Circulation, September 5, 2006; 114(10): 1063 - 1069. [Abstract] [Full Text] [PDF]

				N Ambrosino and M Serradori Determining the cause of dyspnoea: linguistic and biological descriptors Chronic Respiratory Disease, July 1, 2006; 3(3): 117 - 122. [PDF]

				A. A. Chen, M. J. Wood, D. G. Krauser, A. L. Baggish, R. Tung, S. Anwaruddin, M. H. Picard, and J. L. Januzzi NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy Eur. Heart J., April 1, 2006; 27(7): 839 - 845. [Abstract] [Full Text] [PDF]