Abstract
Introduction: The BNP is used as a biomarker of prognosis, in the short term, in patients with heart failure (HF). The prognostic role of the long-term mortality is not enough studied. Objectives: To validate the BNP test as a biomarker of long-term prognosis in patients with suspected HF. Methods: Three hundred eighteen patients, who presented at the emergency room, from March 2003 through September 2009, with suspected HF, took part of this study. The accuracy of BNP to identify patients with heart failure and the search from the association with the level of BNP (POCT Biosite) and with the long-term prognosis were evaluated. The cause of death was identified through the search of death certificates in registries, informed by the Brazilian Information Service of Mortality. Results: Most of the patients were white (93.1%), female (63.8%), and aged 77.3 8.6 years. HF was diagnosed based in a new gold standard that considered the Framingham and Boston criteria plus echocardiography and ECG. HF was present in 170 pt (53.5%). Most of these 108 pt (63.5%) had HF with Preserved Ejection Fraction (HFPEF). The functional class III and IV NYHA was present in 87%. The BNP presented AUC 0.93 (CI 95%, 0.88 to 0.97). The best cutoff of BNP was 180 pg/ml with S 0.83 (CI 95%, 66.7 to 80.4) and Sp 0.90 (CI 95%, 76.7 to 95.4). LR + 6.7 (95 %, 3.1 to 14.3), accuracy of 77.7. In the bivariate analysis BNP> 180pg/ml was associated with a higher risk of mortality. In multivariate analysis HR BNP> 180pg/ml remained associated with increased risk of mortality HR 3.4 (HF 1.2 to 9.6 p 50% and mortality of 26%. The comparison HFS group and NHF showed RRR 0,21 (CI 95% 0,05 – 0,38) p<0,001. Betwin HFPEF group and N-HF group RRR 0,12 (CI 95% -0,02 0,27). HFS and HFPEF the RRR 0,089 (CI 95% -0,67 – 0,24). Ninety nine 99 deaths were recorded in the total group. Conclusion: The level of the BNP showed association with mortality index. The BNP is an independent prognostic biomarker of long-term mortality in patients with HF. Disclosure of Interest: None Declared
Published Version
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