Abstract
IntroductionMonitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome.MethodsThis was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission.ResultsDuring one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% (P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions.ConclusionsBNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT-proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP.Trial registrationClinicalTrials.gov identifier: NCT00514384.
Highlights
Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome
Clinical characteristics and outcome Patients who died during 1-year follow-up had lower body mass index (BMI) (P = 0.001) and estimated glomerular filtration rate (eGFR) (P < 0.001) levels and higher Cardiac troponin T (cTn) (P < 0.001), aspartate aminotransferase (ASAT) (P < 0.05), B-type natriuretic peptide (BNP) (P < 0.001), and NT-proBNP (P = 0.01) levels
In this study, we determined the prognostic value of serial BNP and NT-proBNP measurements and their accuracy to predict 1-year all-cause mortality, 30-day all-cause mortality, and 1-year HF hospitalization in patients presenting with ADHF
Summary
Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome. Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in adults over 65 years [1]. ADHF is still the most costly cardiovascular disorder in Western countries and is associated with a very poor prognosis [1,2,3]. The tools used for the evaluation of disease severity and prognosis in the past have been criticized because epidemiological and clinical factors like age, New York Heart Association (NYHA) functional class, or Killip class were shown to be inadequately sensitive [4]. Recent reports have demonstrated that about 50% of patients admitted with ADHF have a preserved LVEF [6]
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