Prognostic stratification of patients with chronic systolic heart failure using biomarkers and Doppler echocardiography

Stefano Ghio, Giuseppe Alessandrino, Riccardo Albertini, Catherine Klersy, Bruna Girardi, Giannantonio Maggi, Anna S ara Pazzano, Claudia Raineri, Laura Scelsi, Luigi O ltrona Visconti

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Abstract

AIMS: To verify whether a combined assessment of left-ventricular filling pattern at Doppler echocardiography, plasma levels of brain natriuretic peptide (BNP) and high-sensitive troponin I (hsTnI) improves prognostic stratification in patients with chronic systolic heart failure.

METHODS: Three predictors of prognosis were evaluated in 200 consecutive outpatients with heart failure and left-ventricular ejection fraction 35% or less: left-ventricular filling pattern at Doppler echocardiography, BNP plasma levels and hsTnI plasma levels.

RESULTS: During a median follow-up period of 44 months, 15 deaths, two urgent cardiac transplantations, two episodes of ventricular fibrillation and 50 heart failure hospitalizations were observed. The end point of survival analysis was the composite of hard events and hospitalization for acute heart failure. At univariable analysis, the E-wave deceleration time at Doppler echocardiography and BNP plasma level on a continuous log-scale were significantly associated with event-free survival, whereas hsTnI plasma level was not statistically significant. A hierarchical multivariable analysis was performed including a restrictive left-ventricular filling pattern at Doppler as the first prognostic indicator; the subsequent addition of BNP plasma levels above 138  pg/ml (median value) and hsTnI above 0.018  ng/ml (median value) did not further improve prognostic stratification.

CONCLUSION: A restrictive left-ventricular filling pattern at Doppler echocardiography is the most important prognostic indicator in chronic heart failure patients. Plasma levels of BNP and hsTnI do not provide additional relevant information to identify patients at higher risk of cardiovascular outcomes.

Original languageEnglish
Pages (from-to)470-475
Number of pages6
JournalJournal of Cardiovascular Medicine
Volume15
Issue number6
DOIs
Publication statusPublished - Jun 1 2014

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Systolic Heart Failure
Doppler Echocardiography
Troponin I
Brain Natriuretic Peptide
Biomarkers
Heart Failure
Hospitalization
Deceleration
Ventricular Fibrillation
Heart Transplantation
Survival Analysis
Stroke Volume
Disease-Free Survival
Outpatients

ASJC Scopus subject areas

  • Medicine(all)

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Prognostic stratification of patients with chronic systolic heart failure using biomarkers and Doppler echocardiography. / Ghio, Stefano; Alessandrino, Giuseppe; Albertini, Riccardo; Klersy, Catherine; Girardi, Bruna; Maggi, Giannantonio; Pazzano, Anna S ara; Raineri, Claudia; Scelsi, Laura; Visconti, Luigi O ltrona.

In: Journal of Cardiovascular Medicine, Vol. 15, No. 6, 01.06.2014, p. 470-475.

Research output: Contribution to journalArticle

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AU - Albertini, Riccardo

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AU - Girardi, Bruna

AU - Maggi, Giannantonio

AU - Pazzano, Anna S ara

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