 |
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2008, vol. 14, book 1
Subject Collection: Medicine
Page: 89 - 94
DOI: 10.5272/jimab.14-1-2010.89
Online date: 03 April 2009
J of IMAB 2008; 14(1):89-94
NTProBNP AND HRV AND OUTCOME IN PATIENTS WITH HEART FAILURE WITH REDUCED VS. PRESERVED SYSTOLIC FUNCTION
Nadya Stancheva1
, Snezhana Tisheva1, Virginia Jordanova1, Stanimir Kurkchiev2, Assen Goudev3
1) Clinic of Cardiology and Rheumatology, UMHAT “G. Stranski” - Pleven;
2) Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Science - Sofia;
3) Clinic of Cardiology with Intensive care Unit, UMHAT “Tsaritsa Ioanna” – Sofia, Bulgaria
ABSTRACT:
Background: Heart failure /HF/ is usually associated with reduced systolic function. Elevated plasma concentrations of NTproBNP and heart rate variability /HRV/ are predictive of worse outcome in HF patients but there are few data about its predictive value in patients with HF and preserved systolic function.
Purpose and methods: The aim of this study was to determine the prognostic value of predischarge NT-proBNP and heart rate variability (HRV) in patients with reduced vs. preserved systolic function admitted for decompensated congestive HF. One hundred and twenty-seven patients were evaluated at the time of discharge by means of echocardiography, conventional laboratory tests, plasma for NTproBNP and Holter ECG for HRV. The primary endpoints of the study were defined as readmission for HF during the first 6 months after discharge, more than 2 hospitalizations for 1 year, or cardiac death.
Results: One hundred and twenty-one patients /95.3%/ were followed for mean of 387 ± 117 days. Fifty-four patients /44.6%/ had reduced systolic function. Despite of the significant differences in the clinical characteristics of the patients with HF with reduced vs preserved systolic function, prognosis in both groups was poor. Predischarge NTproBNP levels were predictive of worse outcome irrespectively of the systolic function. Kaplan-Meier survival curves showed that NTproBNP > 300 pg/ml was associated with significantly worse outcome in both groups and HRV<20 ms was predictive of event occurrence in the reduced systolic function group. HRV reflected the severity of the systolic dysfunction in the reduced systolic function group.
Conclusions: In hospitalized HF patients predischarge NTproBNP levels are associated with poor prognosis in HF patients irrespective of systolic function while HRV reflects the severity and poor prognosis only of heart failure with reduced systolic function.
Key words: brain natriuretic peptide, heart rate variability, heart failure, prognosis.
- Download FULL TEXT (PDF - 745 KB)
Please cite this article as:
Stancheva N, Tisheva S, Jordanova V, Kurkchiev S, Goudev A. NTProBNP and HRV and outcome in patients with heart failure with reduced vs. preserved systolic function. J of IMAB 2008; 14(1):89-94. DOI: 10.5272/jimab.14-1-2010.89
REFERENCES:
1. Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton GC, et al. The epidemiology of heart failure. Eur Heart J. 1997 Feb;18(2):208-225. [PubMed]
2. Braunwald E. Heart Failure. In: Brauwald et al. Harrison’s principles of internal medicine. 15th ed. New York, McGraw-Hill, 2001:1318-1331.
3. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993 Jul;88(1):107-115. [PubMed] [CrossRef]
4. Abassi Z, Karram T, Ellaham S, Winaver J, Hoffman A. Implications of the natriuretic peptide system in the pathogenesis of heart failure& diagnostic and therapeutic importance. Pharmacol Ther. 2004 Jun;102(3):223-241. [PubMed] [CrossRef]
5. Dokainish H, Zoghbi WA, Lakkis NM, Ambriz E, Patel R, Quinones MA, et al. Incremental predictive power of B-type natriuretic peptide and tissue Doppler echocardiography in the prognosis of patients with congestive heart failure. J Am Coll Cardiol. 2005 Apr 19;45(8):1223-26. [PubMed] [CrossRef]
6. Logeart D, Thabut G, Jourdain P, Chavelas C, Beyne P, Beauvais F, et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of readmission after decompensated heart failure. J Am Coll Cardiol.2004 Fer 18;43(4):645-41. [PubMed] [CrossRef]
7. Gardner RS, Ozalo F, Murday AY, Robb SD, McDonagh TA. N terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J. 2003 Oct;24(19):1735-43. [PubMed] [CrossRef]
8. Hunt PJ, Richardis AM, Nicholls MG, Yandle TG, Doughty RN, Espiner EA. Immunoreactive amino-terminal pro-brain natriuretic peptide (NT-proBNP): a new marker of cardiac impairment. Clin Endocrinol (Oxf) 1997 Sep;47(3):287-96. [PubMed]
9. Ambrose TM. A review of the clinical utility of NTproBNP in the diagnosis, prognosis, and therapy monitoring of patients with congestive heart failure. J Clin Ligand Assay. 2003;25:160-6.
10. Richards AM, Doughty R, Nicholls MG, et al. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischaemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group. J Am Coll Cardiol. 2001;37(7):1781-7.
11. Brouwer J, van Veldhuisen DJ, Man in 't Veld AJ, Haaksma J, Dijk WA, Visser KR, et al. Prognostic value of heart rate variability during long-term follow-up in patients with mild to moderate heart failure. The Dutch Ibopamine Multicenter Trial Study Group.J Am Coll Cardiol. 1996 Nov 1;28(5):1183-1189. [PubMed] [CrossRef]
12. Counihan PJ, Fei L, Bashir Y, Farrell TG, Haywood GA, McKenna WJ. Assessment of heart rate variability in hypertrophic cardiomyopathy. Association with clinical and prognostic features. Circulation. 1993 Oct;88(4 Pt 1):1682-1690. [PubMed] [CrossRef]
13. Mortara A, Tavazzi L. Prognostic implications of autonomic nervous system analysis in chronic heart failure: role of heart rate variability and baroreflex sensitivity. Arch Gerontol Geriatr. 1996 Nov-Dec;23(3):265-275. [PubMed] [PubMed]
14. Takase B, Kurita A, Noritake M, Uehata A, Maruyama T, Nagayoshi H, et al. Heart rate variability in patients with diabetes mellitus, ischemic heart disease, and congestive heart failure. J Electrocardiol. 1992 Apr;25(2):79-88. [PubMed] [CrossRef]
15. Woo MA, Stevenson WG, Moser DK, Trelease RB, Harper RM. Patterns of beat-to-beat heart rate variability in advanced heart failure. Am J Cardiol. 1992 Mar;123(3):704-710. [PubMed] [CrossRef]
16. Lombardi F, Makikallio TH, Myerburg RJ, Huikuri HV. Sudden cardiac death: role of heart rate variability to identify patients at risk. Cardiovascular Research. 2001 May;50(2):210-217. [PubMed] [CrossRef]
17. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (Marek Malik, writing chairman.) Heart rate variability standards of measurement, physiological interpretation, and clinical use. Circulation. 1996; 93:1043-1065.