Relationship between the serum level and its change of N-terminal pro-B-type natriuretic peptides and prognosis of acute decompensated heart failure with preserved ejection fraction in the elderly

Abstract

Objective To assess the prognostic value of the serum level and its change of N-terminal pro-B-type natriuretic peptides (NT-proBNP) in the elderly with acute decompensated heart failure with preserved ejection fraction (HFpEF). Methods A total of 138 consecutive patients (≥65 years old) admitted in Geriatrics and Gerontology Department at Beijing Friendship Hospital were enrolled from June 2013 to June 2015.Demographic characteristics, combination of diseases, medication administration, laboratorial and echocardiographic data were recorded.Meanwhile, NT-proBNP levels at admission, 7th day after admission, changes over 7 days were also recorded and calculated.At the end of 1 year follow up, all patients were divided into events group (n=72) with, and control group (n=66) without, adverse outcomes of heart failure death, heart failure readmission and all-cause death.The differences in NT-proBNP level at admission, 7th day after admission, and its changed value and rate over 7 days were compared between the two groups.Logistic regression was used for analysis of independent risk factors for prognosis.And the cut-off points of NT-proBNP values to predict adverse events were determined by receiver operating characteristic(ROC)curve. Results NT-proBNP values were significantly higher at admission and at 7th days after admission in the events group than in control group(P=0.000). There were no significantly differences in NT-proBNP level and its changes over 7 days between two groups (P=0.370 and P=0.272). Logistic regression analysis showed that NT-proBNP values at admission and 7th days after admission, and NYHA functional classification were independent risk factors for adverse outcomes in 1 year in the elderly with HFpEF (all P<0.05). Furthermore, by the ROC curve, NT-proBNP values at admission and 7th days after admission could predict adverse outcomes including composite endpoints of heart failure, re-admission, heart failure associated death, and all-cause mortality in 1 year. Conclusions Both the plasma NT-proBNP levels at admission and at 7th days after admission have a correlation with prognosis in elderly patients with acute decompensated HFpEF, while changes of NT-proBNP concentration over 7 days could not predict adverse outcomes in this cohort. Key words: Stroke volume; Heart failure; Natriuretic peptide, brain