Prediction of outcome by neurohumoral activation, the six-minute walk test and the Minnesota Living with Heart Failure Questionnaire in an outpatient cohort with congestive heart failure

Aims To compare the recursor of atrial and brain natriuretic peptide (N-ANP, N-BNP), brain natriuretic peptide (BNP), big endothelin-1, the 6-min walk test and the Minnesota Living with Heart Failure Questionnaire (LHFQ) with regard to short-term outcome in an ambulance heart failure population. Methods and Results Ninety-six individuals (left ventricular ejection fraction of 26 +/- 10%) were included in the study. Within 1 day blood samples of N-ANP, N-BNP, BNP and bif endothelin-1 were obtained, and the 6-min walk test and LHFQ were measured. The predictive power of these variables - including renin-angiotensin system antagonist therapy - in respect of 1-year event-free survival were calculated with a Cox regression analysis. All investigated variables had the power to predict outcome in a univariate analysis. Multivariate analysis revealed that N-ANP (chi-square = 58 P<0.001), BNP (chi-square = 8 P<0.01), the LHFQ (chi-square = P<0.02) and the renin angiotensin system antagonist (chi-square = 4 P<0.05), are independent predictors. Conclusions We conclude that in an open clinical cohort of patients with large differences in the progression of teh disease. N-ANP, BNP and LHFQ are the most reliable predictors of worsening heart failure in the short term. However, the dosage of the ACE inhibitor influenced short-term survival in this population.