Pseudonormal or intermediate pattern?

The MUSIC Risk score: a simple method for predicting mortality in ambulatory patients with chronic heart failure

AIMS

The prognosis of chronic heart failure (CHF) is extremely variable, although generally poor. The purpose of this study was to develop prognostic models for CHF patients.

METHODS AND RESULTS

A cohort of 992 consecutive ambulatory CHF patients was prospectively followed for a median of 44 months. Multivariable Cox models were developed to predict all-cause mortality (n = 267), cardiac mortality (primary end-point, n = 213), pump-failure death (n = 123), and sudden death (n = 90). The four final models included several combinations of the same 10 independent predictors: prior atherosclerotic vascular event, left atrial size >26 mm/m(2), ejection fraction < or =35%, atrial fibrillation, left bundle-branch block or intraventricular conduction delay, non-sustained ventricular tachycardia and frequent ventricular premature beats, estimated glomerular filtration rate <60 mL/min/1.73 m(2), hyponatremia < or =138 mEq/L, NT-proBNP >1.000 ng/L, and troponin-positive. On the basis of Cox models, the MUSIC Risk scores were calculated. A cardiac mortality score >20 points identified a high-risk subgroup with a four-fold cardiac mortality risk.

CONCLUSION

A simple score with a limited number of non-invasive variables successfully predicted cardiac mortality in a real-life cohort of CHF patients. The use of this model in clinical practice identifies a subgroup of high-risk patients that should be closely managed.

Isolated diastolic dysfunction--diagnostic value of tissue Doppler imaging, colour M-mode and N-terminal pro B-type natriuretic peptide

INTRODUCTION

For diagnosis of diastolic dysfunction of the left ventricle (DDF), measurement of relaxation velocity (V(R)) by tissue Doppler imaging (V(R)), flow propagation velocity of transmitral inflow (v(p)) as well as the measurement of serum levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) compete with the standard echocardiographic DDF-measures because of several disadvantages of the latter.

METHODS

We examined the diagnostic value of method 1, 2 and NT-proBNP in 120 patients with echocardiographic-proven DDF and in 20 patients without. Patients were classified according to the DDF-stage by standard echocardiographic parameters (transmitral E/A-ratio, deceleration time, isovolumetric relaxation time) into stage I, II and III and furthermore subdivided by the presence of dyspnoea.

RESULTS

V(R) and v(p) were significantly lower in patients with DDF than in patients without DDF, with no difference between the various DDF stages. Symptomatic patients showed a trend to a lower V(R). NT-proBNP was elevated in patients with DDF: Symptomatic patients with a DDF at stage I and patients with a DDF at stage II and III independent of the presence of symptoms had elevated NT-proBNP levels.

CONCLUSION

All three methods tested identified patients with DDF. NT-proBNP and v(p) were able to discriminate between symptomatic and asymptomatic patients.