Abstract
With increasing waiting lists for cardiac transplantation, risk stratification of the individual clinical course of chronic heart failure of potential candidates is a critical part in the candidate selection process. Using a prospective study design, we assessed the value of brain natriuretic pepetide (BNP) to identify heart failure patients with an increased risk of deterioration of their functional status. Furthermore, we examined the relation of BNP and various clinical characteristics incorporated in the Heart Failure Survival Score already clinically established for risk stratification and candidate selection. In 78 patients referred to our heart failure outpatient clinic, plasma BNP levels were compared with the results of the Heart Failure Survival Score. To assess the prognostic power of BNP, the clinical course of this cohort (assessed as improvement, stabilization or deterioration based on history and examination) was monitored for a median follow-up period of 398 days. At study entry, plasma BNP and Heart Failure Survival Score showed a significant correlation (r=-0.706, p<0.0001). During follow-up, Kaplan Meier estimates of freedom from clinical events differed significantly for patients above and below to the 75th percentile concentration of plasma BNP (107.5 pg/ml; p<0.0001). Changes in plasma BNP were significantly related to changes in limitations of physical activity as demonstrated by logistic regression (c2=24.9, p<0.0001). Proportional hazard analysis confirmed BNP as a powerful predictor of deterioration of the functional status (p<0.0001). This prognostic information was as powerful as that derived from the multivariable Heart Failure Survival Score. Patients with high levels of BNP had a substantially higher probability of deterioration of their functional status or death compared to those with only moderately increased levels. Hence, measurement of plasma BNP levels might provide a useful screening tool to preselect potential candidates for transplantation and reduce the need and frequency for more expensive prognostic work-up in patients with advanced CHF.
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