Combining blood flow and tissue Doppler imaging with N-terminal pro-type B natriuretic peptide for risk stratification of clinically stable patients with systolic heart failure

This study was designed to ascertain whether the combination of Doppler assessment of the ratio of mitral blood flow to myocardial early diastolic velocities (E/E(m) ratio) and plasma N-terminal pro-type B natriuretic peptide (NT-proBNP) testing is useful to better stratify patients with stable systolic heart failure (HF). A total of 362 outpatients with chronic systolic HF (left ventricular ejection fraction = 12), 77% in those with the E/E(m) ratio in the intermediate third, and 86% in those with the E/E(m) ratio in the lower third (< 7) (P < 0.0001). By stratifying patients according to NT-proBNP above the median, patients' outcome was predicted in 13 out of 17 in the intermediate third (P = 0.002) and in 9 out of 10 in the lower third of E/E(m) ratio (P= 0.005). In patients with stable HF categorized according to the E/E(m) ratio, NT-proBNP testing improves risk stratification, particularly in those with minor degrees of diastolic dysfunction