Bettencourt et al identified noninvasive prognostic factors for patients with stable mild to moderate heart failure. This can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from Universidade do Porto in Portugal.
Parameters:
(1) Doppler echocardiography of left ventricular diastolic filling (mitral valve in-filling) and/or atrial fibrillation
(2) serum brain natriuretic peptide (BNP) levels (immunoradiometric assay, Shianogi Co Ltd, Osaka, Japan)
(3) distance in meters covered in 6 minutes over a 20 meter course (back and forth)
(4) etiology for heart failure (ischemic vs non-ischemic)
Measurements by Doppler echocardiography during diastole measured (based on mean of 3 measurements):
(1) peak flow velocity in early diastole
(2) deceleration time of the E wave in milliseconds (considered restrictive when less than the median value of 130 ms)
(3) peak flow velocity during atrial contraction
|
Parameter |
Finding |
Points |
|
Doppler echo and/or atrial fibrillation |
no atrial fibrillation and deceleration time of E wave >= median (>= 130 ms) |
0 |
|
|
no atrial fibrillation and deceleration time of E wave < median (< 130 ms) |
1 |
|
|
atrial fibrillation present |
1 |
|
BNP level |
<= median (<=274 pg/mL) |
0 |
|
|
> median (> 274 pg/mL) |
1 |
|
distance walked in 6 minutes |
>= median (>= 350 meters) |
0 |
|
|
< median (< 350 m) |
1 |
|
etiology for heart failure |
nonischemic |
0 |
|
|
ischemic (post-MI) |
1 |
total number of risk factors =
= SUM(points for the 4 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 4
• The higher the score, the worse the cumulative survival.
|
Total Score |
Risk |
Probability of 1 Year Survival |
Probability of 3 Year Survival |
|
0 or 1 |
low risk |
100% |
90% |
|
2 |
intermediate risk |
84% |
66% |
|
3 or 4 |
high risk |
62% |
22% |
from Figure 2, page 310
Transportability:
• 3 of the risk factors were based on the median value shown in the study population.
• The normal reference range for serum BNP was not given.
Specialty: Cardiology
ICD-10: ,
