Predictive Value Of NT-proBNP Research Articles

The Predictive Value of Estimation of N Terminal - Pro B- Type Natriuretic Peptide in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention for the Outcome of Myocardial Reperfusion

Abstract Background Primary PCI is considered to be the preferred reperfusion strategy for STEMI. The goal of reperfusion is to resume normal blood flow to the cardiac tissues, and not just to achieve an open epicardial artery. Aim of the work The aim of this study was to evaluate the predictive value of NT-pro BNP before primary PCI in patients presenting with STEMI, for myocardial reperfusion assessed by the degree of ST resolution in the ECG 90 minutes post primary PCI, the TIMI flow and the MBG post primary PCI. Patients and Methods This study included 40 patients who presented to emergency departments of Ain Shams University hospitals and Misr University for Sciences and Technology hospital from September 2021 till June 2022, diagnosed with STEMI and had been revascularized by primary PCI as per the recommendations of The European society of cardiology guidelines for diagnosis and management of ST elevation myocardial infarction published in 2017. Serum samples for NT-pro BNP level were obtained before primary PCI to be correlated with the TIMI flow grade, the MBG, and the ST resolution post primary PCI. Results Our study had demonstrated that a higher baseline NT-pro BNP level is significantly associated with higher risk of poor myocardial reperfusion following primary PCI expressed by ST resolution less than 50%, TIMI flow grade less than 3 as well as MBG less than 3 and was also associated with higher incidence of No Reflow. Conclusion Initial NT-pro BNP level in STEMI patients correlates with myocardial reperfusion following primary PCI. This supports the potential use of NT-pro BNP as an early marker for risk stratification of patients with STEMI. High risk patients will be in need of more aggressive complementary treatment strategies to improve microvascular perfusion and optimization of the medical therapies to help decrease the development of heart failure.

Commentary on：Predictive value of NT-proBNP and hs-TnT for outcomes after pediatric congenital cardiac surgery.

Commentary on：Predictive value of NT-proBNP and hs-TnT for outcomes after pediatric congenital cardiac surgery.

Predictive value of NT-PROBNP and HS-TNT for in-hospital adverse events after pediatric congenital cardiac surgeries

Predictive value of NT-PROBNP and HS-TNT for in-hospital adverse events after pediatric congenital cardiac surgeries

Impact of age on the predictive value of NT-proBNP in patients with diabetes mellitus stabilised after an acute coronary syndrome

AimsTo assess the impact of age on the prognostic value of NT-proBNP concentration in patients with type-2 diabetes mellitus (T2DM) stabilised after an Acute Coronary Syndrome (ACS). MethodsThe AleCardio study compared aleglitazar with placebo in 7226 patients with T2DM and recent ACS. Patients with heart failure were excluded. Median follow-up was 104 weeks. Baseline NT-proBNP plasma concentration was measured centrally. Multivariable Cox regression was used to determine the mortality predictive information provided by NT-proBNP across age groups. ResultsMedian age was 61y (IQR 54, 67). NT-proBNP concentration increased by quartile (Q) of age (median 264, 318, 391, and 588 pg/ml). Compared to Q1, patients in Q4 of NT-proBNP had higher (p < 0.001) adjusted HR for all-cause (aHR 6.9; 95 % CI 4.0–12) and cardiovascular (11; 5.4–23) death. Within each age Q, baseline NT-proBNP in patients who died was 3 times higher than in survivors (all p < 0.001). When age and NT-proBNP levels were modeled as continuous variables, their interaction term was nonsignificant. The relative prognostic information provided by NT-proBNP (percent of total X2) increased from 38 % in age Q1 to 75 % in age Q4 for mortality, and from 50 % to 88 % for CV death. ConclusionsAmong patients with T2DM stabilised after an ACS, NT-proBNP level predicts death irrespective of age.

NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis.

NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD. The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients. A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; p=0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV1) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV1 ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; p=0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; p=0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; p=0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; p<0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; p<0.0001] showed higher NT-proBNP level. NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.

Oral Presentation Award Winner: The Predictive Value of NT-proBNP across Glomerular Filtration Rate Subsets in Heart Failure Treated Patients.

Oral Presentation Award Winner: The Predictive Value of NT-proBNP across Glomerular Filtration Rate Subsets in Heart Failure Treated Patients.

Predictive value of NT-proBNP in non-obstructive hypertrophic cardiomyopathy

Abstract Background We studied the prognostic value of serum NT-proBNP in nonobstructive hypertrophic cardiomyopathy (nHCM) patients. Methods We studied 777 nHCM patients (55±13 years, 54% men, maximal left ventricular outflow tract gradient [LVOTG] &amp;lt;30 mm Hg) with serum NT-proBNP measured at baseline. We excluded patients with prior septal myectomy (SM) &amp; LV ejection fraction (LVEF) &amp;lt;55%. NT-proBNP was adjusted for age &amp; sex &amp; converted to a log NT-proBNP ratio. Clinical &amp; echo variables were recorded. Primary endpoint was death, appropriate implantable defibrillator (ICD) discharge or heart transplant. Results NT-proBNP ratio was high in 473 and low in 304 patients. Median [interquartile range] LVEF, LVOTG &amp; NT-proBNP were 61% [59, 66], 7 [4, 12] mm Hg &amp; 481 [137–1361] pg/dl. 31% had functional class ≥II &amp; 32% had ≥1 sudden cardiac death risk factor. At 5.3 [3–9] years, 139 (18%) met the primary endpoint (107 deaths). On spline analysis, log NT-proBNP ratio &amp;gt;2.75 was associated with higher events. Cox &amp; Kaplan-Meier survival analyses showed that high NT-proBNP ratio was independently associated with events (Figures 1A-B). In the subgroup of asymptomatic patients, NT-proBNP ratio remained associated with the primary outcome (adjusted HR 1.45, 95% CI 1.10–1.93, P=0.009). Conclusions Higher NT-proBNP ratio (&amp;gt;2.75) is independently associated with adverse outcomes in nHCM, including asymptomatic patients, suggesting risk stratification even in earlier disease stages. Funding Acknowledgement Type of funding sources: None.

Association of N-Terminal Pro-brain Natriuretic Peptide With Volume Status and Cardiac Function in Hemodialysis Patients.

Introduction: N-terminal-pro-brain natriuretic peptide (NT-pro BNP) is secreted by cardiomyocytes in cases of cardiac structure disorder and volume overload. However, the relationship between NT-pro BNP level and body fluid status in dialysis patients with reduced cardiac ejection function (EF) is uncertain. Therefore, we aimed to investigate this relationship.Methods: We enrolled patients who had been receiving hemodialysis for >3 months. Blood sample, transthoracic echocardiographic, and bioimpedance spectroscopy measurements were performed during a midweek non-dialysis day. The predictive value of NT-pro BNP in hemodialysis patients with volume overload was analyzed.Results: A total of 129 hemodialysis patients (74 men and 55 women; mean age: 59.4 ± 13.0 years) were recruited. The average hemodialysis duration was 55.5 (23.9–93.4) months, the NT-pro BNP level was 4992 (2,033–15,807) pg/mL, and the value of overhydration was 2.68 ± 0.19 (−1.9 to 12.2) L. The NT-pro BNP level was independently correlated with overhydration in both the LVEF ≥ 60% (β = 0.236, P = 0.044) and LVEF <60% (β = 0.516, P = 0.032) groups, even after adjustments for potentially confounding variables. In receiver operating characteristic curves of NT-pro BNP for predicting volume overload, the area under the curve was 0.783 [95% CI (0.688–0.879), P < 0.001) and 0.788 [95% CI (0.586–0.989), P < 0.001] in the LVEF ≥ 60% and LVEF < 60% groups, respectively.Conclusions: NT-pro BNP is a predictive factor for volume overload in hemodialysis patients with or without EF declines.

Comparison of predictive value of NT-proBNP, sST2 and MMPs in heart failure patients with different ejection fractions

BackgroundThis study sought to compare the predictive value of NT-proBNP, sST2 and MMPs in HF with different ejection fractions from a population in southern China.MethodsA cross-sectional study was conducted on 113 HF patients admitted to Fujian Provincial Hospital from December 2016 to March 2018.The patients were divided into three subgroups: 60 cases in HFpEF group (LVEF≥50%), 28 cases in HFmrEF group (41% ≤ LVEF≤49%) and 25 cases in HFrEF group (LVEF≤40%). ELISA method was applied to detect the concentrations of sST2, MMP-2 and MMP-9. Electrochemical luminescence immunoassay was applied to detect the concentration of plasma NT-proBNP. Univariate and multivariate Cox and logistic regression models were used to analyze the diagnostic significance of these plasma biomarkers in HF patients. Kaplan–Meier survival curves were used to assess the prognostic value of sST2 in the incidence of long-term adverse events during study.ResultsThis study showed that plasma sST2 levels in HFrEF or HFmrEF patients were significantly higher than in HFpEF patients. Plasma levels of MMP-2 and MMP-9 in HFrEF patients were apparently higher than in HFpEF or HFmrEF patients. For the diagnosis of HFpEF, the AUC of NT-proBNP was higher than that of sST2, MMP-2 and MMP-9, which were 0.881, 0.717, 0.705 and 0.597, respectively. For the diagnosis of HFmrEF, the AUC of plasma sST2 was higher than that of MMP-2, MMP-9 and NT-proBNP, which were 0.799, 0.678, 0.676 and 0.793, respectively. For the diagnosis of HFrEF, the AUC of plasma NT-proBNP, sST2, MMP-2, and MMP-9 were 0.945, 0.820, 0.814, and 0.774 respectively. Spearman correlation analysis showed that plasma sST2 levels were significantly correlated with plasma MMP-2, MMP-9 and NT-proBNP levels. Further logistic regression analysis showed that except MMP-9, the biomarkers sST2 (OR = 1.960), MMP-2 (OR = 0.805) and NT-proBNP (OR = 0.002) were all independent risk factors for patients with heart failure. Survival analysis results suggested that for patients with HFmrEF, a higher level of plasma sST2 (≥ 0.332 ng/ml at admission) may predict a higher risk of endpoint events and a lower survival rate (P < 0.025).ConclusionsThe circulating biomarkers sST2, MMP-2 and NT-proBNP were all independent risk factors for patients with heart failure. The sST2 can be a useful biomarker with both diagnostic and prognostic value in patients with HFmrEF. The higher sST2 level in patients with heart failure was related to a higher incidence of combined endpoint outcome.

CLINICAL IMPLICATIONS OF NT PROBNP LEVEL IN PATIENTS WITH MYOCARDIAL INFARCTION COMPLICATED BY ATRIAL FIBRILLATION

Our aim was to study the predictive value of NT proBNP regarding the risk of AF and clinical features in acute phase of ST-segment elevation MI (STEMI). Methods. We examined 56 patients with STEMI and AF who did undergo the primary PCI. 35 (62.5 %) of patients had the new-onset AF (group 1), 21 (37.5 %) had pre-existing AF (group 2). Control group consisted of 60 patients with STEMI without AF (group 3). Results. Group 3 patients were more likely to be smokers than patients in group 2. They had lower admission heart rate and glycemia, lower NT proBNP, higher hemoglobin and ejection fraction. Patients in group 1 were more likely to have anterior MI, left anterior descending artery as an infarction-related artery (IRA) and adverse cardiac events (MACEs). Patients in group 2 had higher left atrium end-systolic diameter and were more likely to have three-vessel injury. NT proBNP correlated positively with age, admission glycemia, mean PA pressure and negatively – with GFR. ROC analysis had shown the cut-off point of NT proBNP level for prediction of AF was &gt;1050 pg/ml. Cut-off point for prediction of the risk of MACE in STEMI complicated with AF was &gt;2189 pg/ml. Discussion. It was shown that NT proBNP is higher in STEMI patients who have AF. Increased NT proBNP is associated with the risk of adverse events in acute STEMI phase. NT proBNP level can be utilized as AF predictor in STEMI patients and as predictor of MACEs in patients with STEMI and AF.

Comparison of dialysate and plasma NTproBNP in prediction of clinical outcomes ofdiabetic and nondiabetic peritoneal dialysis patients .

Plasma level of N-terminal pro-brain natriuretic peptide (P-NTproBNP) is a useful marker in prediction of mortality in peritoneal dialysis (PD) patients. However, the predictive value of spent dialysate counterpart (D-NTproBNP) of plasma NTproBNP on mortality and dropout is not known. Simultaneous P-NTproBNP and D-NTproBNP assays were performed after an overnight dwell in 44 scheduled ambulatory PD patients. Patients were followed for ~47 months. Deceased patients or patients who were transferred to hemodialysis were regarded as dropouts. 14 patients (31.8%) dropped out at ~4 years (9deaths and 5transfers to hemodialysis). Diabetics, males, and patients with higher membrane permeability had higher dropout rates. Patients with P- and D-NTproBNP higher than median values had higher mortality and dropout rates (Kaplan-Meier test, log-rank Test p<0.05). Odds ratios of D-NTproBNP for death and dropouts were (3.807 (0.907-15.971), p=0.068) and (2.87 (1.009-8.138) p=0.048), respectively; odds ratios of P-NTproBNP for death and dropouts were (4.652 (0.914-23.693), p=0.064) and (2.67 (0.924-7.716), p=0.07), respectively; in ROC analysis for death, AUC for P- and D-NTproBNP were 0.762 (0.578-0.946, p=0.016) and 0.765 (0.590-0.940, p=0.015), respectively. Exclusion of diabetic patients from the analyses resulted in significant changes in the predictive value P- and D-NTproBNP. Although death and dropout rates were still higher in nondiabetic patients with higher NTproBNP levels, the differences between groups lost statistical significance. Both P-NTproBNP and D-NTproBNP are significant predictors of outcomes of interest. Predictive value of NTproBNP might be different in diabetics and non-diabetic CAPD patients. .

Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery

ObjectiveThe primary aim was to investigate the role of underlying heart disease on preoperative NT-proBNP levels in patients admitted for adult cardiac surgery, after adjusting for the known confounders age, gender, obesity and renal function. The second aim was to investigate the predictive value of preoperative NT-proBNP with regard to severe postoperative heart failure (SPHF) and postoperative mortality.MethodsA retrospective cohort study based on preoperative NT-proBNP measurements in an unselected cohort including all patients undergoing first time surgery for coronary artery disease (CAD; n = 2226), aortic stenosis (AS; n = 406) or mitral regurgitation (MR; n = 346) from April 2010 to August 2016 in the southeast region of Sweden (n = 2978). Concomitant procedures were not included, with the exception of Maze or tricuspid valve procedures.ResultsPreoperative NT-proBNP was 1.67 times (p<0.0001) and 1.41 times (p<0.0001) higher in patients with AS or MR respectively, than in patients with CAD after adjusting for confounders.NT-proBNP demonstrated significant discrimination with regard to SPHF in CAD (AUC = 0.79, 95%CI 0.73–0.85, p<0.0001), MR (AUC = 0.80, 95%CI 0.72–0.87, p<0.0001) and AS (AUC = 0.66, 95%CI 0.51–0.81, p = 0.047). In CAD patients NT-proBNP demonstrated significant discrimination with regard to postoperative 30-day or in-hospital mortality (AUC = 0.78; 95%CI 0.71–0.85, p<0.0001). The number of deaths was too few in the AS and MR group to permit analysis. Elevated NT-proBNP emerged as an independent risk factor for SPHF, and postoperative mortality in CAD.ConclusionsPatients with AS or MR have higher preoperative NT-proBNP than CAD patients even after adjusting for confounders. The predictive value of NT-proBNP with regard to SPHF was confirmed in CAD and MR patients but was less convincing in AS patients.

Comparative evaluation of copeptin and NT-proBNP in patients with severe acute decompensated heart failure, and prediction of adverse events in a 90-day follow-up period: A prospective clinical observation trial.

The present study compared the prognostic value of a marker, the C-terminal section of the arginine vasopressin prohormone (copeptin), with N-terminal B-type natriuretic peptide (NT-proBNP) in patients with severe acute decompensated heart failure. A prospective, observational cohort study was conducted in a tertiary care hospital and enrolled 129 patients with severe acute decompensated heart failure. Clinicians were blinded to investigational markers except NT-proBNP, and the study participants were followed up for 90 days. The end-point was a composite of cardiovascular death or re-hospitalization due to decompensated heart failure. Of the 129 patients enrolled, 47 reached the end-point and 82 were in a stable condition during follow-up. Receiver operating characteristic curve analysis revealed that the areas under curve for the prediction of adverse events within 90 days were similar for copeptin [0.602±0.052; 95% confidence interval (CI), 0.499-0.705], NT-proBNP (0.659±0.048; 95% CI, 0.565-0.753) and their combination (0.670±0.050; 95% CI, 0.573-0.767). Kaplan-Meier survival analysis showed that the predictive value of NT-proBNP regarding the probability of survival was superior compared with that of copeptin (log-rank test for trend, P=0.001 vs. 0.040). Furthermore, multivariate Cox proportional-hazards regression analysis revealed that increased NT-proBNP and copeptin plasma concentrations were significant independent predictors of adverse events. The present study provided evidence that copeptin has similar predictive properties compared with NT-proBNP regarding adverse events within 90-days in patients with severe acute decompensated heart failure, but that copeptin may not provide superior 90-day prediction compared to NT-proBNP.

Abstract 18551: Predictors of Heart Failure and Death in a High Risk Diabetic Population: The DAVID-Berg Study

Introduction: Diabetic subjects are at high risk of heart failure (HF) and death. Few data are available on the predictive value of NTproBNP, ECG, and echocardiogram in this population Hypothesis: A screening strategy with NTproBNP, ECG, and echo may improve prediction of HF/death events in a diabetic population in HF-stages A &amp; B, beyond clinical data Methods: In 2008, among 4047 subjects aged &gt;55 and &lt;80 yrs treated by three general medicine group practices, the DAVID-Berg study enrolled all subjects with diabetes &amp;/or hypertension &amp;/or cardiovascular disease, without history/symptoms/signs of HF (n=623). Subjects underwent clinical visit, 12-lead ECG, echocardiogram, NTproBNP point of care testing. Recently data on HF/death events have been prospectively collected for all diabetic subjects included in the study (n=198) Results: Median age of the study population was 69 yrs, 62% were men, mostly hypertensive (86%) with known cardiovascular disease (44%). During a median follow-up of 5.2 [4.9,5.5] yrs there were 45 HF/death. At Cox regression analyses univariate predictors of events were known cardiovascular disease, insulin therapy, chronic kidney dysfunction (CKD), NTproBNP≥300 pg/mL, abnormal ECG (atrial fibrillation &amp;/or LV hypertrophy &amp;/or bundle branch block &amp;/or Q wave), left atrial volume index (LAVI)≥40 mL/m 2 , LV ejection fraction (LVEF)≤55%, and LV mass index. At multivariate analyses (stepwise forward selection applied to univariate predictors), clinical variables (CKD and known cardiovascular disease), ECG (HR 2.66 [95% CI 1.08-6.55]), LAVI≥40 mL/m 2 (HR 2.50 [95% CI 1.28-4.89]), and LVEF≤55% (HR 2.70 [95% CI 1.45-5.04]) remained significantly associated with the outcome. Adding sequentially NTproBNP, ECG, and echo (LAVI, LVEF) to clinical data improved event prediction (Figure) Conclusions: High risk diabetic subjects may be correctly risk stratified integrating sequentially clinical data with NTproBNP, ECG, and echocardiogram

The influence of renal function on the prognostic value of Nt-pro brain natriuretic peptide in St-elevation myocardial infarction

In patients with ST elevation myocardial infarction (STEMI) NT-pro brain natriuretic peptide (NT-pro BNP) [1,2] and estimated glomerular filtration rate (eGFR) [3] were associated with increased risk of mortality. Previous studies examined the association between renal function and NT-pro BNP, with apparently discrepant results [4–7]. In patients undergoing non vascular surgery [8] the discriminative value of NT-pro BNPwasmostpronounced inpatientswithGFRN90 ml/min/1.73 m2and had no prognostic value in patients with GFR b30 ml/min/1.73 m2. No data are so far available on this topic in STEMI patients. Therefore, the present investigation, performed in 646 consecutive STEMI patients all submitted to mechanical revascularization, was aimed at assessing: a) the influence of eGFR on the predictive value of NT-pro BNP and b) the utility of combining eGFR and NT-pro BNP to stratify risk of mortality at short and long term. From the 1st of January 2007 to 30th of June 2010, 646 consecutive patients with STEMI (within 12 hours from symptoms' onset), were admitted to our intensive cardiac care unit (ICCU), after primary PCI [8–16]. Wemeasured glucose (mg/dl), insulin values (mIU/l) [17], glycated hemoglobin (HbA1c, %), troponin I (ng/ml), C-reactive protein (mg/ dl), NT-pro brain natriuretic peptide (NT-pro BNP) (pg/ml) [13] and uric acid (mg/dl) [18]. Acute insulin resistance was measured by means of homeostatic model assessment (HOMA) [19–21]. Worsening in renal function (WRF) was defined as an increase in creatinine ≥0.3 mg/dl, as previously described [22–24]. The study protocol was in accordance with the Declaration of Helsinki and approved by the local Ethics Committee. Informed consent was obtained in all patients before enrollment. [25]. Categorical data are reported as frequencies (percentages) and analyzed by means of χ (or Fisher's exact text, when predicted counts in almost one cell were less than 5). Continuous data are reported as means±SD or medians (95% confidence interval—CI) according to their normal or not normal distribution (assessed by means of Kolmogorov– Smirnovone-sample normality test) andanalyzed bymeans of Student's t-test or Mann–Whitney U-test, respectively. Correlations between Log NT-pro BNP levels and variables (age, log BMI, admission systolic blood pressure, admission LVEF, admission eGFR, admission glycemia, Log TnI, uric acid, Log CRP, gender) were tested by Pearson correlation. A multivariate linear regression analysis was performed to identify factors that were associated with levels of NT-pro BNP for the whole study population, and in stratified analysis according to eGFR. A multivariable logistic regression analysis was carried out considering as outcome in-ICCU death. Model calibrationwas assessed by means of Hosmer–Lemeshow goodness-of-fit test; Nagelkerke pseudo-R square is also reported. To predict long-term mortality we performed Kaplan– Meier event curves, stratified according to eGFR and NT-pro BNP, about clinical cut-off values (60 ml/min/1.73 m,1000 pg/ml, respectively) and in paired combinations. Long time survival was explored, after proportionality of risk assessment, with multivariable Cox regression analysis. In all multivariable analyses, candidate variables were chosen as those considered clinically relevant or that showed a univariate relationship with outcome; nonsignificant ones were dropped by means of backward selection. A two-tailed p value b0.05 was considered statistically significant (PASW 17.0 statistical package, SPSS Inc, Chicago, IL). In our series, 129 patients (20%) exhibited an eGFR b60 ml/min/ 1.73 m (Group B). Group A was younger (pb0.001) and with a lower incidence of diabetes (p=0.002), previous PCI (pb0.001) and previous MI (pb0.001). Higher Killip classes were more frequent in Group B (pb0.001) who showed a lower admission and discharge LVEF (pb0.001 and pb0.001, respectively). A higher mortality rate both in-ICCU and at follow-up was observed in Group B (pb0.001 and pb0.001, respectively). When combining eGFR and NT-pro BNP (Fig. 1), the highest mortality was observed in patients with eGFR b60 ml/min/1.73 m and NT-pro BNP ≥1000 pg/ml (pb0.001). A higher incidence of more advanced coronary artery disease and PCI failure was observed in Group B (p=0.044 and p=0.039, respectively).

The clinical significance of N-terminal brain natriuretic peptide on acute ST-segment elevation myocardial infarction patients

ObjectiveTo evaluate the relationship between N-terminal brain natriuretic peptide (NT-proBNP) and prognosis of acute ST-segment elevation myocardial infarction (STEMI), the predictive value of NT-proBNP in coronary artery multi-vessel disease, and...

P-05 Predictive value of NT-proBNP in the occurrence of postoperative atrial fibrillation in cardiac surgery with cardiopulmonary bypass

P-05 Predictive value of NT-proBNP in the occurrence of postoperative atrial fibrillation in cardiac surgery with cardiopulmonary bypass

Serial NT-proBNP measurements for risk stratification of patients with decompensated heart failure

NT-proBNP is an important prognostic predictor in patients with heart failure. However, it is unknown whether a change of NT-proBNP plasma levels in the early phase of decompensation might be of additional prognostic value in patients with acute decompensation of heart failure. NT-proBNP plasma levels of 116 patients with decompensated heart failure from ischemic/non-ischemic origin were measured at baseline and at 12, 24 and 48 h after hospital admission. Baseline levels and changes of plasma levels within the first 48 h were correlated with 30-day mortality. In all patients, NT-proBNP 12 h after admission was highest and superior with respect to the prediction of 30-day mortality compared to plasma levels on admission. In total, 38 patients died within the first 30 days. In these patients absolute NT-proBNP plasma levels were significantly higher and the increase within 12 h after admission was more pronounced compared to survivors (p<0.001). NT-proBNP at 12 h after admission also had the highest predictive value for the 30-day mortality rate in patients with acute myocardial infarction. The increase of NT-proBNP plasma levels within 12 h after admission had the highest predictive value in patients suffering from decompensated heart failure. NT-proBNP is a powerful marker of 30-day mortality in patients with decompensated heart failure of ischemic and non-ischemic origin. Compared with single baseline measurements, serial measurements of NT-proBNP plasma levels within 12 h after hospital admission may be used to increase the predictive value of NT-proBNP with regard to the early identification of patients who are at high risk of mortality.

Predictive Value of NT-proBNP in Vascular Surgery Patients with COPD and Normal Left Ventricular Systolic Function

ABSTRACTN-terminal pro-B-type natriuretic peptide (NT-proBNP) is commonly used to identify a cardiac cause of dyspnoea. However, patients with chronic obstructive pulmonary disease (COPD) may also have increased plasma NT-proBNP levels because of right-sided myocardial stress caused by pulmonary hypertension. We investigated the relationship between COPD and elevated NT-proBNP levels as well as the impact of elevated NT-proBNP levels on mortality in vascular surgery patients with normal left ventricular systolic function. Prior to vascular surgery, NT-proBNP levels, pulmonary function and left ventricular ejection fraction (LVEF) were assessed in 376 patients. Only patients with a LVEF > 40%% were included; n == 261. Elevated NT-proBNP levels were defined as ≥500 pg/ml. Firstly, we assessed the relationship between COPD and NT-proBNP levels. Secondly, we investigated the association between elevated NT-proBNP levels and one-year mortality. COPD was independently associated with elevated NT-proBNP levels (OR 3.36, 95%%CI 1.30–8.65) with significant associations found for mild and severe COPD. Elevated NT-proBNP levels were associated with increased one-year mortality in patients with (HR 7.73, 95%%CI 1.60–37.43) and without COPD (HR 3.44, 95%%CI 1.10–10.73). COPD was associated with elevated NT-proBNP levels in patients with a normal LVEF undergoing vascular surgery. Elevated NT-proBNP levels independent of other well-established risk factors were associated with increased one-year mortality. NT-proBNP may be useful biomarker to risk stratify patients with COPD.

Predictive value of NT-pro BNP after acute myocardial infarction: Relation with acute and chronic infarct size and myocardial function

We sought to assess the relation of N-terminal brain natriuretic peptide (NT-pro BNP) determined on day 3 after onset of acute myocardial infarction (AMI) symptoms with acute and chronic infarct size and functional parameters assessed by cardiac magnetic resonance (CMR) imaging. Furthermore, we wanted to investigate its predictive value for recovery of myocardial function. CMR was performed in 49 consecutive patients within 6 days and in a subgroup 4 (n = 27) and 12 (n = 22) months after first acute ST-elevation AMI and successful primary angioplasty. NT-pro BNP was measured in the subacute phase at 66 ± 8 h after onset of symptoms. Log-transformed NT-pro BNP (lgNT-pro BNP) significantly correlated with infarct size in % of left ventricular myocardial mass (r = 0.59 to 0.64; p < 0.004), with ejection fraction (EF) (r = -0.49 to -0.55; p < 0.004) as well as with segmental wall thickening (SWT, mm) (r = 0.41 to -0.52; p < 0.04) at any time of assessment. Multiple linear regression analysis revealed baseline EF and lgNT-pro BNP to predict global functional recovery. Patients with NT-pro BNP concentrations <the mean level of 1115 pg/ml significantly improved in EF and SWT (all p < 0.02) during the study period, whereas patients with NT-pro BNP >1115 pg/ml did not show significant functional recovery (all p = NS). NT-pro BNP on day 3 after admission correlates with acute and chronic infarct size and myocardial function after AMI. Global and regional myocardial function did not recover in patients with higher NT-pro BNP (>1115 pg/ml) during subacute phase of AMI.