Heart failure
Independent Value of Echocardiography and N-Terminal Pro-Natriuretic Peptide for the Prediction of Major Outcomes in Patients With Suspected Heart Failure

https://doi.org/10.1016/j.amjcard.2007.04.027Get rights and content

N-terminal pro–B-type natriuretic peptide (NT–pro-BNP) and echocardiography have been shown to have diagnostic and prognostic value for the assessment of heart failure (HF) in the community. This study evaluated whether echocardiography and serum NT–pro-BNP estimation have independent value for the prediction of major outcome in patients with suspected HF from the community. Accordingly, 137 patients with suspected HF referred from the community were followed up after undergoing clinical assessment, electrocardiography, NT–pro-BNP estimation, and echocardiography. Abnormal echocardiogram was defined as visual left ventricular ejection fraction ≤45% or left atrial volume index >26 ml/m2 or presence of left ventricular hypertrophy or significant valvular heart disease. Data were obtained in 132 patients (96%) over a mean follow-up period of 26 ± 7 months during which 19 (14%) developed major cardiac events (14 deaths and 5 HF admissions). Univariate predictors for major cardiac event were age (p = 0.05), male gender (p = 0.007), presence of clinical signs of HF (p = 0.02), NT–pro-BNP level ≥50 pmol/L (p <0.001), abnormal electrocardiogram (p = 0.02), and abnormal echocardiogram (p = 0.004). However, the only independent predictors were male gender (odds ratio 3.09, 95% confidence interval 1.01 to 9.46, p = 0.05), NT–pro-BNP level ≥50 pmol/L (odds ratio 5.78, 95% confidence interval 1.63 to 20.5, p = 0.007), and abnormal echocardiogram (odds ratio 11.1, 95% confidence interval 1.43 to 85.6, p = 0.02). In conclusion, NT–pro-BNP and abnormal echocardiogram provided independent information for predicting adverse outcome in patients with suspected HF referred from the community.

Section snippets

Methods

Patients referred to our community echocardiographic service by general practitioners with symptoms and signs suggestive of HF underwent clinical assessment, venesection for serum NT–pro-BNP, electrocardiography, and echocardiography. Inclusion criteria were age >18 years and symptoms (shortness of breath or fatigue or ankle swelling) and signs suggestive of suspected HF. Exclusion criteria included metastatic cancer or inability to co-operate as a result of mental incapacity such as dementia.

Results

A total of 137 patients with suspected HF referred from the community was evaluated. Five patients were lost during follow-up due to relocation to another area. Therefore, follow-up data were obtained in 132 patients, 19 (15%) of who developed an event over a mean follow-up time of 26 ± 7 months. Of the 19 events, 14 (11%) were deaths and 5 (4%) were HF admissions. Of these 132 patients being followed up, the prevalence of LV systolic dysfunction (LVEF ≤45%) was 22% (30 of 132), isolated

Discussion

This is the first study to demonstrate that a combination of abnormal echocardiographic parameters independently predicted major outcome (mortality or HF admission) in patients with suspected HF referred by general practitioners from the community for echocardiographic assessment. Male gender and increased NT–pro-BNP were other independent predictors of major outcome. Furthermore, a combination of male gender, abnormal echocardiogram, and NT–pro-BNP provided the most powerful prognostic

Acknowledgment

We are grateful to Paul Bassett, BSc, MSc, who provided statistical support.

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    The work was supported by a grant from the Cardiac Research Fund, Northwick Park Hospital, Harrow, United Kingdom.

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