Multiparametric Risk Stratification in Patients With Mild to Moderate Chronic Heart Failure

Background: Whether brain natriuretic peptide (BNP) combined with cardiopulmonary exercise test(CPx) and echocardiographic findings improves prognostic stratification in mild-to-moderate systolic heart failure (HF) is unclear. Methods and Results: A total of 244 consecutive stable outpatients, median age of 71 (62e76) years, with New York Heart Association (NYHA) Class I-III HF and left ventricular ejection fraction (LVEF)45% underwent BNP measurement, Doppler echocardiography, and a maximal CPx. Median BNP was 166 (70e403) pg/mL, median LVEF 35% (28%-40%). A restrictive filling pattern (RFP) was present in 44 patients (18%). At CPx, peak oxygen uptake was 12 (9.7, 14.4) mL/kg/min and an enhanced ventilatory response to exercise (EVR, slope of the ventilation to CO2 production ratio,