Beside B-type natriuretic peptide in the emergency diagnosis of systolic and nonsystolic heart failure: Results from the breathing not properly (BNP) multinational study

Abstract

Background: The impact of creatinine levels on plasma concentrations as well as the prognostic value of N-terminal proENP (pmBNP) was evaluated in patients with symp- toms of congestive heart failure (CHF) at rest or on minimal exertion. Methods: Plasma concentrations of proBNP, were measured using a newly developed sandwich ELISA in a subgroup of 1048 patrents of the European part of the COPERNI- CUS study. Results: ProBNP baseline values, mean*SD. were 74lilO16 pmol/L in patients with ele- vated (a=125 U/L) creatinine, compared to 403~461 pmollL in patients with normal (cl25UiL) creatinine (p=O.OOOl, Wilcoxon P-sample test). A significant positive correla- tion (r= 0.35, p=O.OOOl, Pearson Correlation Coefficient) was detected between proBNP and creatinine. By multivariate Cox regression, NT-proBNP but not creatinine was a pow- erful independent indicator of subsequent cardiac events. A statistical significant creati- nine-proBNP interaction could be detected (p=O.O2 for the primary endpoint), indicating that the prognostic value of proBNP for survival is not constant Over the range of creati- nine. Risk ratios for proBNP levels below vs. above median are indicated in the table according to quartiles of baseline creatinine. Conclusions: In patients wtth advanced CHF treated wrthin the COPERNICUS study, proBNP plasma concentrations are related to creatinine both at baseline and during treatment. In addihon, baseline creatinine levels seam to influence the prognostic value of proBNP concentrations.