Abstract 17732: Combination of B-Type Natriuretic Peptide and Minute Ventilation Carbon Dioxide Production Slope Improves Risk Stratification in Patients with Diastolic Heart Failure

Abstract

Objectives To investigate the prognostic values of the minute ventilation/carbon dioxide production slope (VE/VCO 2 ) and peak oxygen consumption (VO 2 ) for cardiovascular and all-cause mortality in diastolic heart failure. Background Recent studies have demonstrated that VE/VCO 2 was more powerfully predicted mortality, hospitalization, or both than VO 2 in systolic heart failure. Methods and Results The outpatients previously diagnosed as diastolic heart failure were recruited from April 2006 to March 2007, and underwent cardiopulmonary exercise testing and echocardiographic examination. Plasma BNP concentration was measured. Total of 224 patients were enrolled. During a mean follow-up of 30 months, 57 patients died (36 from cardiovascular death). Univariate Cox regression analysis showed that age, New York Heart Association function class, atrial fibrillation, diabetes mellitus, left ventricular diastolic dysfunction, peak VO 2 , VE/VCO 2 , and plasma BNP were significantly associated with mortality risk. Multivariate analysis revealed that plasma BNP, VE/VCO 2 , and age remained independent predictors for both cardiovascular and all-cause mortality, with the strongest prognostic values of plasma BNP (chi square =35.9 vs 39.8; P<0.001). In addition to clinical risk factors and plasma BNP, The VE/VCO 2 could provided incremental and independently prognostic information of cardiovascular (chi square =60.6 vs 51.7; P=0.009) and all-cause mortality (chi square =62.8 vs 54.2; P=0.015) with increased chi square value of Cox regression model. Conclusion In patients with diastolic heart failure, plasma BNP is the strongest predictor of mortality risk, and VE/VCO 2 , but not peak VO 2 , provides addictive independent prognostic information, which suggests that combination of plasma BNP and VE/VCO 2 can improve risk stratification.