Failing heart—medical aspects
Aminoterminal pro type B natriuretic peptide as a predictive and prognostic marker in patients with chronic heart failure

https://doi.org/10.1016/j.healun.2004.07.006Get rights and content

Background

B-type natriuretic peptide (BNP) is released from the cardiac ventricles in response to increased wall tension. We studied the relation of NT-proBNP to Heart Failure Survival Score (HFSS) and New York Heart Association (NYHA) class in patients with chronic heart failure (CHF). We also studied the impact for recipient selection for cardiac transplant and assessed it as a predictive and prognostic marker of CHF.

Methods

A total of 550 patients with dilative cardiomyopathy (n = 323), and coronary artery disease (n = 227) were prospectively examined. All patients underwent spiroergometry, echocardiography, right heart catheterization, and electrocardiogram. Routine blood levels and NT-proBNP were measured. The clinical selection for cardiac transplant candidates was adjudicated by 2 independent cardiologists who were blinded to the results of NT-proBNP assays. Clinical outcome and predictive power of NT-proBNP were analyzed.

Results

NT-proBNP levels in patients clinically considered for cardiac transplantation were significantly higher (2293 ng/ml vs 493 ng/ml; p < 0.001). The receiver operating characteristic (ROC) analysis regarding transplant candidacy showed an area under the ROC curve (AUC) of 0.84 ± 0.01 for HFSS, 0.86 ± 0.001 for NYHA, and 0.96 ± 0.01 for NT-proBNP. Patients with increasing NT-proBNP levels or remaining elevated levels despite adequate heart insufficiency treatment were maintained with left ventricular assist device implantation (n = 10) or urgent heart transplantation (n = 2). Patients with NT-proBNP levels above 5000 pg/ml had a mortality rate of 28.4% per year. Twenty-eight patients died during the observation period; all these patients were within NYHA Classes 3 and 4 (NT-proBNP 5423 ± 423 ng/ml).

Conclusions

NT-proBNP discriminates patients at high likelihood of being a candidate for transplantation and provides prognostic informations in patients with CHF. NT-proBNP levels above 5000 pg/ml at admission were associated with death, and these levels markedly discriminated candidates for left ventricular assist devices or urgent transplantation.

Section snippets

Patients

Between January 2002 and January 2004, a total of 550 consecutive patients with heart failure due to left ventricular dysfunction, either as a result of coronary artery disease (CAD) or dilative cardiomyopathy (DCM), presenting to our Interdisciplinary Heart Failure Program were investigated. No exclusion criteria were defined. Patients in good clinical conditions (NYHA Class 1) served as reference group. The demographic data and patient characteristics are shown in Table 1. In all patients,

Baseline characteristics

A total of 550 patients were prospectively investigated. The demographics and baseline characteristics for the study sample according to the underlying heart disease are reported in Table 1. No differences between groups regarding weight, heart rate, ejection fraction, shortening fraction, mean arterial pressure, cardiac index, serum sodium, serum creatinine, and HFSS were observed. Patients with DCM were significantly taller (p < 0.01). Their ventricular diameters left ventricular enddiastolic

Discussion

The poor prognosis associated with advanced heart failure has been demonstrated by Gardner and coworkers.22 They described a 1-year mortality of approximately 15% among patients suffering from advanced heart failure. The recent COPERNICUS Study has provided comparable 1-year mortality rates of 18.5% in the placebo-treated group and 11.4% in the carvedilol-treated group.23, 24 The high mortality rates of end-stage heart failure make it desirable that parameters be found that help identify

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