Abstract 23: N -Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP) vs. BNP for Predicting Heart Failure in Patients with Stable Coronary Artery Disease: the Heart and Soul Study.

Abstract

Background The B-type natriuretic peptide (brain natriuretic peptide [BNP] and its amino terminal pro-BNP [NT-proBNP]) are powerful predictors of adverse cardiovascular outcomes, including heart failure (HF), in patients with coronary artery disease (CAD). However, their relative prognostic utility remains uncertain. We compared the ability of NT-proBNP and BNP to predict HF hospitalizations in patients with stable CAD. Methods We studied the relative prognostic utility of NT-proBNP and BNP in 983 participants with stable CAD from the Heart and Soul Study. The primary outcome was time to HF hospitalization. Results During an average of 6.7 ± 3.0 years follow-up, there were 173 hospitalizations for HF. NT-proBNP and BNP levels were strongly correlated with one another (r=0.87; p<0.001). In demographically-adjusted models, HF hospitalization was predicted similarly by NT-proBNP (HR per 1-SD increase in log-transformed level: 3.1; 95% C.I. 2.7 - 3.7; p<0.001) and BNP (HR per 1-SD increase in log-transformed level: 3.0; 95% C.I. 2.5 - 3.6; p<0.001). This finding persisted after adjustment for traditional coronary risk factors, history of HF, left ventricular (LV) systolic and diastolic function and LV mass index, with NT-proBNP (HR per 1-SD increase in log-transformed level: 3.4; 95% C.I. 2.5 - 4.5; p<0.001) and BNP (HR per 1-SD increase in log-transformed level: 3.0; 95% C.I. 2.3 - 3.8; p<0.001) continuing to predict the primary outcome similarly. Moreover, in fully adjusted ROC analyses, NT-proBNP (AUC 0.87) and BNP (AUC 0.86; p=0.19 for comparison) performed similarly for predicting HF hospitalization. Conclusions NT-proBNP and BNP are secreted in equimolar amounts and perform similarly for predicting HF hospitalization in patients with stable CAD. This suggests that their relative prognostic utility is not affected by differences in their biological half-lives, in vitro stability and mechanisms of clearance.