Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent p...Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT- BNP. Analysis was performed on 261 patients(132 DDD, 121 VVI, eight others), mean age 73± 12 years, range 34- 99 years. Seventy two subjects(27% ) had heart failure as defined by left ventricular ejection fraction(LVEF) ≤ 40% and symptoms of heart failure(NYHA class II, III, or IV). Screening with NT- BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve(AUC) 0.76, P< 0.001, 95% CI 0.69- 0.83]. This increased in subjects with a DDD type pacemaker(sensitivity 80% , specificity 66% , AUC=0.8, CI 0.7- 0.90) and reduced in subjects with a VVI type pacemaker(sensitivity 66% , specificity 61% , AUC 0.68 CI 0.57- 0.78). Conclusion: Symptoms of heart failure are common in patients with pacemakers. Screening with NT- BNP is feasible and assists in the detection of important cardiac co- morbidity, particularly in patients with a DDD type pacemaker.展开更多
Aims: The 6-min walk test(6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure(CHF):(i) 1 year reproducibility of the 6-MWT;(ii) sensitivity of the 6-MWT to self-perc...Aims: The 6-min walk test(6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure(CHF):(i) 1 year reproducibility of the 6-MWT;(ii) sensitivity of the 6-MWT to self-perceived changes in symptoms of heart failure; and(iii) implications for patient numbers required for studies using the 6-MWT as an endpoint have not been described. Methods and results: One thousand and seventy-seven patients with CHF, aged >60, with NYHA Class ≥II were recruited. Heart failure symptom assessment was determined using a questionnaire related to aspects of physical function, and patients performed a baseline 6-MWT, with follow-up 1 year later. Seventy-four patients with unchanged symptoms had an unchanged 6-MWT distance, with an overall intraclass correlation coefficient of 0.80(95%CI=0.69-0.87). Four hundred and twenty-three patients reported an improvement in symptoms during follow-up. There was a negative correlation(r=-0.55; P=0.0001) between Δsymptoms and Δ6-MWT(i.e. a reduced 6-MWT distance is associated with reduced symptom severity at follow-up). Five hundred and sixteen patients reported worsening symptoms of heart failure, a moderate inverse correlation(r=-0.53; P=0.0001) was displayed between Δsymptoms and Δ6-MWT. For all patients, irrespective of symptom status, a high inverse correlation(r=-0.75; P=0.0001) was evident. On the basis of the data for patients with unchanged symptoms, it is calculated that to detect an increase in 6-MWT of 50 m, with 90%power, a study size of approximately 120 is required. Conclusion: In elderly patients with CHF, the 6-MWT shows satisfactory agreement when repeated 1 year later. Change in 6-MWT distance is sensitive to change in self-perceived symptoms of heart failure.展开更多
文摘Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT- BNP. Analysis was performed on 261 patients(132 DDD, 121 VVI, eight others), mean age 73± 12 years, range 34- 99 years. Seventy two subjects(27% ) had heart failure as defined by left ventricular ejection fraction(LVEF) ≤ 40% and symptoms of heart failure(NYHA class II, III, or IV). Screening with NT- BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve(AUC) 0.76, P< 0.001, 95% CI 0.69- 0.83]. This increased in subjects with a DDD type pacemaker(sensitivity 80% , specificity 66% , AUC=0.8, CI 0.7- 0.90) and reduced in subjects with a VVI type pacemaker(sensitivity 66% , specificity 61% , AUC 0.68 CI 0.57- 0.78). Conclusion: Symptoms of heart failure are common in patients with pacemakers. Screening with NT- BNP is feasible and assists in the detection of important cardiac co- morbidity, particularly in patients with a DDD type pacemaker.
文摘Aims: The 6-min walk test(6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure(CHF):(i) 1 year reproducibility of the 6-MWT;(ii) sensitivity of the 6-MWT to self-perceived changes in symptoms of heart failure; and(iii) implications for patient numbers required for studies using the 6-MWT as an endpoint have not been described. Methods and results: One thousand and seventy-seven patients with CHF, aged >60, with NYHA Class ≥II were recruited. Heart failure symptom assessment was determined using a questionnaire related to aspects of physical function, and patients performed a baseline 6-MWT, with follow-up 1 year later. Seventy-four patients with unchanged symptoms had an unchanged 6-MWT distance, with an overall intraclass correlation coefficient of 0.80(95%CI=0.69-0.87). Four hundred and twenty-three patients reported an improvement in symptoms during follow-up. There was a negative correlation(r=-0.55; P=0.0001) between Δsymptoms and Δ6-MWT(i.e. a reduced 6-MWT distance is associated with reduced symptom severity at follow-up). Five hundred and sixteen patients reported worsening symptoms of heart failure, a moderate inverse correlation(r=-0.53; P=0.0001) was displayed between Δsymptoms and Δ6-MWT. For all patients, irrespective of symptom status, a high inverse correlation(r=-0.75; P=0.0001) was evident. On the basis of the data for patients with unchanged symptoms, it is calculated that to detect an increase in 6-MWT of 50 m, with 90%power, a study size of approximately 120 is required. Conclusion: In elderly patients with CHF, the 6-MWT shows satisfactory agreement when repeated 1 year later. Change in 6-MWT distance is sensitive to change in self-perceived symptoms of heart failure.
