Abstract 18486: Serial Measurements of High-Sensitive Cardiac N-terminal Pro B-type Natriuretic Peptide Predict Prognosis of Ambulant Chronic Heart Failure Patients: Results of the Bio-shift Study

Abstract

Introduction: N-terminal pro B-type natriuretic peptide (NT-proBNP) has prognostic value in chronic heart failure (CHF) patients, but most studies evaluated single or few measurements only. Hypothesis: We think that longer term NT-proBNP patterns in CHF patients facilitate assessing prognosis. Methods: From 2011 to 2013, 263 ambulant CHF patients were included in 2 hospitals. NT-proBNP was measured at baseline and every 3 months. The primary endpoint (PE) comprised heart failure (HF)-hospitalization and cardiovascular mortality. The association between NT-proBNP pattern and the PE was assessed by a statistical method that combines a mixed model, describing temporal evolution of NT-proBNP, with Cox proportional hazards regression. Results: Mean age was 67 (SD 13) years, 72% were men and 27% were NYHA class III-IV. During a median follow-up of 1.0 (IQR 0.6-1.4) years 885 samples (median 3 (IQR 2-5) per patient) were drawn. The PE was reached in 41 patients (16%). Median baseline NT-proBNP was 137 (IQR 50-274) ng/L, which was higher in patients with PE than in those without (297 (IQR 186-687) ng/L vs. 110 (IQR 38-235) ng/L; age- and sex adjusted hazard ratio (HR) for doubling of baseline NT-proBNP: 1.21; 95% CI 1.13-1.30). The median of the last NT-proBNP before a PE was 308 (IQR 201-831) ng/L. Age- and sex adjusted NT-proBNP increased before an event, and this temporal pattern was associated with increased risk of PE: doubling of NT-proBNP over time resulted in 2.09 times increased risk (95% CI 1.71-2.56). Conclusions: Temporal patterns of NT-proBNP are associated with HF-hospitalizations and cardiovascular mortality in CHF patients. NT-proBNP was steady in stable patients, but increased before an event. This pattern was expected based on clinical experience, yet has never been quantified prospectively.