Combination of B-type natriuretic peptide and peak oxygen consumption improves risk stratification in outpatients with chronic heart failure

Peak oxygen consumption is a cornerstone for prognostic determination in patients with congestive heart failure. The purpose of this study was to assess whether plasma B-type natriuretic peptide (BNP) provided any additional prognostic information. Plasma concentrations of atrial natriuretic peptide, N terminal pro-atrial natriuretic peptide, BNP, endothelin-1, norepinephrine, and peak VO 2 were measured in 250 consecutive outpatients with mild to moderate heart failure (96% in New York Heart Association [NYHA] class II or III) and left ventricular ejection fraction (LVEF) 137 pg/mL (median value), compared with 100% and 89%, respectively, when plasma BNP was ≤137 pg/mL ( P = .008). Furthermore, plasma BNP was the only independent predictor of sudden death (χ 2 = 19.9, P = .00001). Plasma BNP provides additive independent prognostic information compared to peak VO 2 alone in outpatients with mild to moderate heart failure.