Prognostic Value Of NT-proBNP Research Articles

Diagnostic and prognostic value of NT-proBNP in patients with non-alcoholic fatty liver disease and acute decompensated heart failure

Abstract Funding Acknowledgements None. Aim To study N-terminal propeptide natriuretic hormone (NT-proBNP) values in patients with non-alcoholic fatty liver disease (NAFLD) with acute decompensated heart failure (ADHF) at admission and discharge to evaluate its impact on clinical outcomes. Material and methods Included were 566 patients hospitalized with ADHF, functional classes II–IV (NYHA) [49,3% men, mean age 72,4 ± 11.4 years, left ventricular ejection fraction (LVEF) - 45 (33; 55) %. Patients were divided into 2 groups: 1 – ADHF and NAFLD (n=168), 2 – ADHF without NAFLD (n=398). All patients had NT-proBNP levels determined upon admission and discharge. The degree of liver steatosis was determined using a sensor device using the CAP (Controlled Attenuation Parameter) ultrasound option. Threshold CAP values corresponded to the degree of hepatic steatosis - S0 (<294 dB/m), S1 (295-309 dB/m), S2 (310-330 dB/m), S3 (≥331 dB/m). Results NAFLD was diagnosed in 29.7% of all patients. The incidence of NAFLD was higher in patients with preserved LVEF - 43% vs 25% - reduced LVEF. Patients with severe steatosis (S3) had significantly lower NT-proBNP values than patients with moderate steatosis (S1,S2) and no steatosis (S0) at admission [926 (256;1870) pg/ml, 1246 (298; 2000) pg/ml, 1850 (798;3515) pg/ml, respectively, p<0.001] and at discharge [480 (107;1406) pg/ml, 1077 (250;1649) pg/ml, 1685 (628;2733) ) pg/ml, respectively, p<0.001]. In patients with NAFLD and ADHF, according to multivariate Cox regression analysis, NTproBNP level >1593 pg/ml at discharge (hazard ratio (HR) 3.14; 95% confidence interval (CI) 1.52– 6.43; p<0.001) and LVEF<40% (HR 2.90; 95% CI 1.46–5.76; p=0.002) were independently associated with a higher likelihood of all-cause death during the 3-year follow-up period. Conclusions NAFLD and ADHF group was characterized by lower NT-proBNP values, with an inverse correlation with the degree of steatosis, which may complicate timely diagnosis and prescription of adequate therapy. At the same time, assessment of NTproBNP and LVEF values in patients with ADHF and NAFLD at discharge had an important prognostic role for stratifying by risk of death from all causes during the observed period, despite lower NTproBNP threshold values.

Prognostic value of NT-proBNP in the new era of heart failure treatment.

Heart failure is one of the leading causes of mortality and hospitalization in cardiovascular patients. Guideline-directed medical treatment (GDMT) in the current era includes novel medications such as ARNI and SGLT2 inhibitors, as well as an approach to treatment based on clinical phenotypes. To assess prognostic factors for mortality and hospital readmissions plays a crucial role in patient care. This study aimed to determine the rate of 90-day post-discharge events in patients having heart failure with reduced ejection fraction (HFrEF) and investigate the associated clinical factors. A prospective study was conducted on 110 HFrEF patients at the cardiology department of Cho Ray Hospital. The 90-day events included all-cause mortality and rehospitalization due to heart failure. The rate of 90-day events was 45.6%. After multivariable Cox regression analysis, NT-proBNP level ≥ 1858 pg/mL was identified as an independent factor associated with the 90-day events. NT-proBNP cut-off ≥ 1858 pg/mL can be used for the prognosis of 90-day events in HFrEF.

Determinants of NT-proBNP Levels in patients with a systemic right ventricle: a new cut-off level for risk stratification?

Abstract Introduction The role of N-terminal natriuretic peptide (NT-proBNP) in the risk prediction of patients with a systemic left ventricle is indisputable. However, its value in patients with a systemic right ventricle (sRV) is not well defined. Method Ninety-eight patients with NT-proBNP values at baseline from the randomized clinical trial SERVE were included. The correlation between baseline NT-proBNP values and parameters of bi-ventricular volumes and function quantified by cardiac magnetic resonance was assessed by means of adjusted linear regression models. The prognostic value of NT-proBNP and other established prognostic markers were assessed by means of adjusted cox proportional hazards model, survival analysis and c-statistic. The primary outcome was defined as the occurrence of either clinically relevant arrhythmia, heart failure or death. Results Median age [interquartile range, IQR] at baseline was 39 years [32,48] and 32% were female. Median NT-proBNP was 238 [137,429] ng/L. Coefficients of determination for the relationship between NT-proBNP levels and right ventricular end-systolic and end-diastolic volume index, and ejection fraction (RVEF) were +0.481, p<0.001; +0.427, p<0.001; and -0.561, p<0.001, respectively. The sex and age adjusted hazard ratio [95% confidence interval, CI] for NT-proBNP values above the 75th percentile (429ng/L) showed an exponential increase (Figure) and there was a significant difference in survival comparing the group above our cut-off value and the group below it (Table). After adjusting for age and sex, the prognostic value of NT-proBNP was comparable to the prognostic value of RVEF and predicted VO2 max (C-statistic: 0.71, 0.72 and 0.71, respectively). Conclusion NT-proBNP levels correlated significantly with right ventricular parameters assessed by means of CMR. Measurement of NT-proBNP is a reliable and convenient tool for the prediction of adverse outcomes in patients with a sRV and using the cut-off value of 429ng/L could assist in the risk stratification for this population.

Prognostic value of NT-proBNP and cardiac troponin levels in ambulatory patients with congestive heart failure - Insight from NHANES

Abstract Background Recently there has been increased interest in the utility of cardiac troponin and NT-proBNP to predict the prognosis in patients with CHF. The aim of this study was to investigate the prognostic significance of NT-proBNP and cardiac troponin in CHF patients in ambulatory settings. Methods The NHANES, conducted by the National Center for Health Statistics, collects nationally representative data on the health and nutritional status of the non-institutionalized US population. We included heart failure patients aged ≥ 40 years with valid entries for NT-proBNP and cardiac troponin. We used data collected during the period 1999 -2004. The primary endpoint was all-cause mortality. Vital status (dead or alive) was determined by linkage to a record match of the National Death Index, conducted by the National Center for Health Statistics through December 31, 2020. Follow up period was from the examination date to either the date of death or December 31, 2020, whichever came first. NT-proBNP and cardiac troponin levels were stratified into tertiles, and mortality was assessed using cox proportional hazard mortality multivariate logistic regression models. K-M survival curves were used to display mortality over time. All analyses were done using STATA version 17, with p-values less than 0.05 considered statistically significant. Results In all, there were 551 persons, corresponding to 4.4 million, with a diagnosis of CHF. Of this, 379, corresponding to 4.1 million persons, were retained for analyses. Hypertension (61.6%), diabetes (34.26%), CKD (32.7%), nicotine use (65.45%), and cardiovascular diseases (CVD) were the most prevalent comorbidities. On the multivariate analysis, compared to lower tertile for elevated NT-proBNP, being in the middle tertile increased the risk of all-cause mortality up to 54% (HR 1.54, CI 1.03 – 2.3, P = 0.035) and up to 2 fold for being in upper tertile (HR 1.95, CI 1.29 – 2.96, P = 0.002)(Figure 1). Similarly, compared to the lower tertile for elevated troponin, being in the upper tertile increased the risk of all-cause mortality up to threefold (HR 2.84, CI 1.82- 4.44, P = 0.000) while being in the middle tertile could not achieve statistical significance for predicting the outcome (HR 1.44, CI 0.95 - 2.17, P = 0.082)(Figure 2). Among other predictors included in the analysis, CKD and history of smoking were associated with overall worse survival (HR 1.68, CI 1.25- 2.23, P = 0.000) and (HR 1.5, CI 1.099-2.076, P = 0.011), respectively. Conclusion CHF patients in the middle and upper tertile for NT-proBNP and cardiac troponin compared to the lower tertile showed an overall poor prognosis on follow up in the ambulatory settings. Our findings suggest that monitoring NT-proBNP and cardiac troponin levels can be useful tools for predicting prognosis. Further studies are needed for the clinical implications of this strategy.K-M survival estimates for NT-proBNPK-M survival estimates for troponin

Associations of N-terminal pro-B-type natriuretic peptide, estimated glomerular filtration rate, and mortality in US adults

NT-proBNP is an important predictor of mortality but is inversely related to estimated glomerular filtration rate (eGFR). Whether the prognostic value of NT-proBNP is similar at different levels of kidney function is unknown. We evaluated the association of NT-proBNP with eGFR and its implications for all-cause and cardiovascular mortality risk in the general population. We included adults without prior cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. We used linear regression to characterize the cross-sectional associations of NT-proBNP with eGFR. We used Cox regression to assess the prospective associations of NT-proBNP with mortality across categories of eGFR. Among 11,456 participants (mean age 43 years, 48% female, 71% White, 11% Black), there was an inverse association between NT-proBNP and eGFR, which was stronger in those with more impaired kidney function. Per 15-unit decrease in eGFR, NT-proBNP was 4.3-fold higher for eGFR<30; 1.7-fold higher for eGFR 30 to 60, 1.4-fold higher for eGFR 61 to 90, 1.1-fold higher for eGFR 91 to 120 mL/min/1.73 m2. Over a median 17.6 years of follow-up, 2,275 deaths (622 cardiovascular) occurred. Higher NT-proBNP was associated with higher all-cause (HR per doubling of NT-proBNP: 1.20, 95% CI: 1.16-1.25) and cardiovascular mortality (HR: 1.34, 95% CI 1.25-1.44). Associations were similar across eGFR categories (P-interaction >.10). Adults with NT-proBNP≥450 pg/mL and eGFR<60 mL/min/1.73m2 had 3.4-fold higher all-cause mortality and 5.5-fold higher cardiovascular mortality risk, compared to those with NT-proBNP<125 pg/mL and eGFR>90 mL/min/1.73m2. Despite its strong inverse association with eGFR, NT-proBNP has robust associations with mortality across the full range of kidney function in the general US adult population.

Prognostic Value of NT-proBNP and Some Coagulation Markers in Severe COVID-19 Patients

Prognostic Value of NT-proBNP and Some Coagulation Markers in Severe COVID-19 Patients

Prognostic Value of NT-proBNP and 3 Months Readmission or Mortality after Congenital Heart Surgery

Prognostic Value of NT-proBNP and 3 Months Readmission or Mortality after Congenital Heart Surgery

Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure

BackgroundThis study aimed to evaluate whether glomerular filtration rate (eGFR) during admission modifies the predictive value of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) in patients hospitalized for acute heart failure (AHF). MethodsWe retrospectively evaluated 4595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 2008 through October 2019. To investigate the effect of kidney function on the association of NT-proBNP and CA125 with 1-year mortality (all-cause and cardiovascular mortality), we stratified patients according to four eGFR categories: <30 mL•min–1•1.73 m–2, 30–44 mL•min–1•1.73 m–2, 44–59 mL•min–1•1.73 m–2, and ≥60 mL•min–1•1.73 m–2. Biomarkers were assessed within the first 24 hours following admission. ResultsAt 1-year follow-up, 748 of 4595 (16.3%) patients died after discharge (of all deaths, 575 [12.5%] were cardiovascular). After multivariate adjustment, both NT-proBNP and CA125 remained independently associated with a higher risk of death when modeled as main effects (P<0.001). However, we found a differential prognostic effect of NT-proBNP across eGFR categories for both endpoints (all-cause mortality, P-value for interaction=0.002; CV mortality, P-value for interaction=0.001). Whereas NT-proBNP was positively and linearly associated with mortality in the subset of patients with normal or mildly reduced eGFR, its predictive ability progressively decreased at the lower extreme of eGFR (<45 mL•min–1•1.73 m–2). In contrast, the association between CA125 and survival remained consistent across all eGFR categories (all-cause mortality, P-value for interaction=0.559; CV mortality, P-value for interaction=0.855). ConclusionsIn patients with AHF and severely reduced eGFR, CA125 outperforms NT-proBNP in predicting 1-year mortality.

Prognostic value of NT-proBNP and best cut-offs for risk prediction in obese patients with chronic systolic heart failure

Abstract Background N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) is a strong predictor of outcome in chronic systolic heart failure (CHF). Although plasma NT-proBNP has been reported to display an inverse correlation with body-mass-index (BMI), its prognostic value in obese patients has been poorly investigated so far. Objectives To evaluate the prognostic value and the best cut-offs for risk prediction of NT-proBNP in obese individuals from a multinational cohort of patients with systolic CHF. Methods We analyzed data from the BIOS (Biomarkers In Heart Failure Outpatient Study) Consortium. Patients with left ventricular ejection fraction (LVEF) ≤50% were selected and classified as nonobese (BMI &amp;lt;30 kg/m2), mildly obese (BMI 30–35 kg/m2), moderately obese (BMI 35–40 kg/m2), or severely obese (BMI ≥40 kg/m2), according to standard nomenclature. Clinical and bio-humoral data, including NT-proBNP testing, were retrieved, and 5-year cardiac and all-cause mortality status were considered as primary and secondary outcome, respectively. The independent prognostic role of NT-proBNP was evaluated through Cox regression analysis, adjusting the model for age, gender, New York Heart Association class, ischaemic aetiology, LVEF, and estimated glomerular filtration rate (eGFR). Results The study population included 11,574 patients (age 65±12 years, LVEF 30±9%, males 78%). Most of patients were nonobese (n=8,937, 77%), while mildly, moderately, and severely obese patients were 1,887 (16%), 499 (4%), and 251 (3%), respectively. Median values of plasma NT-proBNP were progressively lower from nonobese to mildly, moderately, and severely obese patients (1455 ng/L, 903 ng/L, 767 ng/L, 660 ng/L, respectively) and BMI was predictive of NT-proBNP independently from age, LVEF, and eGFR (r=−0.152, p&amp;lt;0.001). The best NT-proBNP cut-offs to predict 5-year cardiac mortality were significantly lower in mildly [1044 ng/L; AUC 0.663 (Sen 66%; Spe 59%), p&amp;lt;0.001] moderately [736 ng/L; AUC 0.670 (Sen 76%; Spe 52%), p&amp;lt;0.001]), and severely [1060 ng/L; AUC 0.635 (Sen 57%; Spe 69%), p=0.021] obese patients compared to nonobese individuals [2034 ng/L; AUC 0.714 (Sens. 65%; Spec. 66%), p&amp;lt;0.001]. Further, NT-proBNP independently predicted 5-year cardiac death in nonobese, mildly and moderately obese patients (all p&amp;lt;0.001), but not in severely obese patients (p=0.457). Similar findings were observed for the secondary endpoint of 5-year all-cause mortality. Conclusions Compared to nonobese CHF patients, obese patients have lower circulating NT-proBNP levels, which retain independent prognostic significance for cardiac and all-cause mortality across most categories of obesity. BMI-adjusted NT-proBNP cut-offs might be considered for prognostic stratification in obese patients with CHF. Funding Acknowledgement Type of funding source: None

Prognostic value of NT-proBNP, and echocardiographic indices of diastolic function, in hospitalized patients with acute heart failure and preserved left ventricular ejection fraction

BackgroundSeveral parameters have proven useful in assessing prognosis in outpatients with heart failure with preserved ejection fraction (HFpEF). In contrast, prognostic determinants in HFpEF hospitalized for an acute event are poorly investìgated. AimTo determine the predictive value of NT-proBNP, and diastolic function (assessed by E/e’), in patients with HFpEF hospitalized for acute heart failure. Methods and resultsWe evaluated 205 consecutive HFpEF patients admitted for acute heart failure (median age: 76[53,81], 36% male, median EF: 61 [54,77]). We assessed clinical, echocardiographic, and NT-proBNP values, on admission and at discharge. Primary end-point was the composite of all-cause death and/or HF rehospitalization.After a mean follow up of 28±10 months, 82 patients met the primary end-point; there were 30 deaths (14.6%), and 72 patients (35%) were rehospitalized for HF. By multivariable analysis, predictors of the composite end-point were: discharge E/e´ ≥14 (HR: 4.63 CI 95%: 2.71-18.2, p<0.0001), discharge NT-proBNP ≥1500 pg/ml (HR: 5.23, CI 95%: 2.87–17.8, p < 0.0001), ≥50% NT-proBNP decrease between admission and discharge (HR: 0.62, CI 95%: 0.25-0.79, p = 0.019). Combining E/e´ and NT-proBNP values at discharge further and significantly improved discrimination power compared to each variable analyzed separately (AUC, NT-proBNP at discharge: 0.80; E/e´ at discharge: 0.77; E/e´ + NT-proBNP: 0.88; p < 0.01). ConclusionsIn HFpEF patients hospitalized with acute heart failure, assessment of E/e´ ratio and NT-proBNP at discharge provides prognostic information on top of other variables, and allows to easily identify a population at higher risk of subsequent death or rehospitalization for heart failure, during a medium-term follow up.

Prognostic value of perioperative NT-proBNP after corrective surgery for pediatric congenital heart defects

BackgroundIt is critically important to assess the prognostic value of NT-proBNP in the form of repeated measures among children undergoing surgery for congenital heart defects (CHD). The aim of the present study is to assess the value of repeated perioperative NT-proBNP in evaluating the time dependent and temporal trajectory in prognostics diagnosis during the perioperative period in a large series of children with CHD.MethodsRepeated measures of NT-proBNP from 329 consecutive children with CHD were obtained before and 1, 12, and 36 h after surgery, respectively. For fully utilizing longitudinal characteristics, we employed parallel cross-sectional logistic regression, a two stage mixed effect model and trajectories over time analysis to mine the predictive value of perioperative NT-proBNP on the binary outcome of prolonged intensive care unit (ICU) stay.ResultsThe two stage mixed effects model confirmed that both the mean NT-proBNP level (aOR = 1.46, P = 0.001) and the time trends had prognostic value on the prediction of prolonged ICU stay. In the fully adjusted logistic regression analyses based on gaussian distributions, “rapidly rising NT-proBNP” put the subjects at 5.4-times higher risk of prolonged ICU stay compared with “slowly rising” group (aOR = 5.40, P = 0.003).ConclusionsComprehensive assessment of the time dependent and temporal trajectory in perioperative NT-proBNP, indicated by repeated measurements, can provide more accurate identification of children with higher risk of prolonged ICU stay after CHD surgery.

P3515Gender differences in plasma levels and prognostic value of NT-proBNP in chronic heart failure

Abstract Background Natriuretic peptides are established biomarkers of heart failure (HF). The existence of gender-related differences in circulating levels and prognostic value are still controversial. Methods Individual patient data from studies assessing cardiac biomarkers (N-terminal fraction of pro-B-type natriuretic peptide - NT-proBNP - and high-sensitivity troponin T) for risk prediction in stable chronic HF were analysed. Results Women (n=1964, 23%) had higher median [interquartile interval] NT-proBNP concentrations than men (1678 [659–4215] vs. 1294 [522–2973] ng/L, p&lt;0.001). Female gender predicted higher NT-proBNP independently from age, body mass index, glomerular filtration rate, left ventricular ejection fraction (LVEF), and atrial fibrillation. Over a 2.4-year follow-up (1.6–3.2), 2351 patients (27%) died, and cardiovascular death occurred in 1558/8271 (19%). HF hospitalization was recorded in 2088/7944 (26%) over 2.0 years (1.3–2.6). Women and men had similar areas under the curve for the 3 endpoints, with higher cut-offs among women: all-cause death, 2328 ng/L vs. 1319 ng/L; cardiovascular death, 2328 ng/L vs. 1413 ng/L; HF hospitalization, 1265 ng/L vs. 907 ng/L. In the prognostic model above, the risk of the three endpoints increased by 32%, 35%, and 17%, respectively, per doubling of NT-proBNP in women, and by 41%, 45%, and 30% in men. Conclusions Women with chronic HF display higher NT-proBNP levels than men in the whole population as well as across many patient subgroups. This difference is not entirely explained by heterogeneity in age, BMI, or renal function. NT-proBNP holds independent prognostic significance in both genders, although alternative prognostic cut-offs might be considered for women.

P3535Prognostic value of congestion status by bioelectrical impedance analysis and natriuretic peptide levels in acute heart failure with preserved versus reduced left ventricular ejection fraction

Abstract Background N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known predictor of acute heart failure (HF). Congestion volume status estimated by bioelectrical impedance analysis (BIA) is also associated with adverse cardiovascular events in HF patients. However, it is unclear whether these biomarkers reflecting pathophysiological pathways are different between HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). Purpose The aim of this study was to investigate whether the prognostic value of NT-proBNP and extracellular water/free fat mass (ECW%) assessed by BIA is different between HFrEF and HFpEF in acute HF patients. Methods and results One hundred-and-forty-three patients admitted for acute HF between November 2013 and January 2015 were estimated for NT-proBNP levels and ECW% by BIA on admission. A total of 49 HFrEF (LVEF&lt;40%) and 75 HFpEF (LVEF≥50%) patients were included in this study (mean age: 76±14 years, male: 63%). The median of NT-proBNP levels in HFrEF patients was higher than in HFpEF (6022 [IQR: 2531–9163] pg/mL and 3179 [1076–6054] pg/mL, respectively, p=0.012). Conversely, ECW% was similar between HFrEF and HFpEF (29.0 [25.7–33.7] % and 31.7 [27.3–38.8] %, respectively, p=0.088). The primary endpoint was the composite of all-cause mortality and/or hospitalisation due to HF. During a median follow-up of 5.9 months, 16 (35.6%) and 35 (50.7%) patients were observed to have composite events in HFrEF and HFpEF, respectively, (p=0.111). Elevated NT-proBNP levels in HFrEF patients were associated with an increased risk of composite events after adjustment for traditional risk factors (hazard ratio [HR]: 2.39; 95% Confidence interval [CI]; 1.04–5.47; p=0.040), but not in HFpEF (p=0.063). Meanwhile, a high ECW% in HFrEF patients was associated with increasing composite events risk (HR: 3.30; 95% CI; 1.32–8.25; p=0.011), as well as in HFpEF patients (HR: 1.62; 95% CI; 1.03–2.55; p=0.037). Furthermore, the ECW% in addition to NT-proBNP in HFpEF patients resulted in a significant improvement in prediction for composite events (net reclassification improvement 0.67 [95% CI 0.24–1.11]; p=0.002 and integrated discrimination improvement 0.12 [0.004–0.20]; p=0.004). Conclusion Elevated levels of NT-proBNP in acute HF were predictive for mortality and hospitalisation due to HF in HFrEF but may not be for HFpEF patients, and ECW% had a better predictive value than NT-proBNP in HFpEF patients.

Prognostic Value of NT-proBNP in Acute ST Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention

Prognostic Value of NT-proBNP in Acute ST Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention

Prognostic Value of NT-proBNP in Predicting Adverse In-hospital Outcomes among Patients of STEMI getting Thrombolytic therapy without Clinical Manifestation of Heart Failure

Background: Risk stratification is extremely important in ACS patients especially acute STEMI. We studied in-hospital outcomes of acute STEMI according to their NT-proBNP level as a new prognostic marker.Methods: This observational prospective study was conducted to evaluate the significance of raised plasma NT-proBNP level on in-hospital outcomes in patients with STEMI, without clinical manifestation of heart failure. A total 88 patients of STEMI were included in the study. Among them 10 Patients have normal levels of NT-proBNP (&lt;110 pg/ml) and were included in Group-A (n = 10). Patients with increased proBNP level (e”110 pg/ml) were included in Group-B (n = 78). Patients were followed to see worse in-hospital outcomes (Heart failure, cardiogenic shock, significant arrhythmia and death) during index hospitalization period.Results: Plasma NT-proBNP level was observed to be significantly higher among patients who developed heart failure, cardiogenic shock and death than the patients who did not developed these outcome (p &lt; 0.001). The binary logistic regression analysis of Odds Ratios for characteristics of the patients likely to cause worse in-hospital outcome shows that NT-ProBNP and smoking habit were found to be the independent predictors of worse in-hospital outcome with ORs being 5.0 and 4.7 respectively.Conclusion: On admission plasma NT-pro BNP level in patients with STEMI is a strong independent predictor of adverse in-hospital outcome.Cardiovasc. j. 2017; 10(1): 8-12

Prognostic role of N-terminal pro-brain natriuretic peptide in asymptomatic hypertensive and diabetic patients in primary care: impact of age and gender : Results from the PROBE-HF study.

The association between natriuretic peptides and clinical outcome in asymptomatic hypertensive and diabetic patients with no clinical evidence of heart failure (HF) is still unclear. We assessed the prognostic value of NT-pro BNP, and its interactions with age and gender, in a cohort of asymptomatic, stage A/B HF hypertensive and diabetic patients enrolled in primary care. NT-proBNP was measured in 1012 asymptomatic subjects with systemic hypertension and/or type-2 diabetes (age 66.6±7.8years, 48% males) with no clinical evidence of HF. Patients were prospectively followed over 49.8±6.7months for the development of cardiac death, HF hospitalization, and nonfatal myocardial infarction. Patients with NT-proBNP above the 80th age- and gender-specific percentile showed a threefold risk of events as compared to those with NT-proBNP under this cut-off [hazard ratio 3.2 (2.6-8.3), p<0.0001]. In multivariable analysis, NT-proBNP added independent and incremental prognostic information to a predictive model including established risk factors (p<0.0001). After stratification by age, increased NT-proBNP predicted outcome among patients in the second and third age tertiles, but not among those in the first tertile. Increased NT-proBNP was associated with a 3.6-fold risk in women and a 2.9-fold risk in men. Addition of the gender-NT-proBNP interaction to prognostic models further improved prediction of events (p=0.014). NT-proBNP measurement adds independent and incremental information for the prediction of clinical outcome in asymptomatic, stage A-B HF hypertensive and diabetic patients taken from primary care. This prognostic value might be further evident in the elderly and among women.

Prognostic Value of NT-proBNP after Atrial Redirection Surgery

After atrial redirection surgery NT-proBNP correlates with NYHA-class, ventricular function and subaortic AV-valve regurgitation (TR). The impact on adverse clinical outcome is unknown.

Prognostic value of NT-proBNP in patients with systemic morphological right ventricles: A single-centre experience

In systemic morphological right ventricles after atrial redirection surgery, NT-proBNP is correlated with NYHA-class, ventricular function and subaortic AV-valve regurgitation (TR). The impact of NT-proBNP on adverse clinical outcomes is, however, unknown. MethodsThis prospectively designed, longitudinal, observational study evaluated NT-proBNP in 116 patients (24.9±4.2years old, NYHA class I/II/III=97/18/1, 71 men) relative to all cardiac causes of hospitalisation, heart failure, transplantation and death. ResultsThe mean observation time was 7.3±2.4years. In univariate Cox proportion analysis, the predictors for all causes of hospitalisation (n=41; 35.5%) were NT-proBNP (HR: 5.99; 95%CI: 3.21–11.18), NYHA class (HR: 2.98; 95%CI: 1.62–5.5), ventricular function (HR: 1.96; 95%CI: 1.27–3.02), TR (HR: 2.39; 95%CI: 1.48–3.59), ventricular septal defect repair (HR: 1.29; 95%CI: 1.08–1.53) and a history of supraventricular tachycardia (SVT) (HR: 7.13; 95%CI: 3.74–13.59). In multivariate Cox proportion analysis, NT-proBNP (HR: 3.71; 95%CI: 1.82–7.57), SVT (HR: 4.27; 95%CI: 2.03–8.94) and ventricular septal defect repair (HR: 1.41; 95%CI: 1.15–1.72) remained independently associated with all causes of hospitalisation.For heart failure, transplantation and death, the single predictors were NT-proBNP (HR: 20.67; 95%CI: 4.69–91.78), NYHA class (HR: 6.45; 95%CI: 2.75–15.14), ventricular function (HR: 2.70; 95%CI: 1.48–4.92), TR (HR: 4.11; 95%CI: 1.99–8.47), QRS duration (HR: 2.09; 95%CI: 1.06–4.12) and SVT (HR: 8.00; 95%CI: 2.82–22.69). Multivariate Cox proportion analysis identified NT-proBNP (HR: 6.82; 95%CI: 1.32–35.04) and NYHA class (HR: 6.79; 95%CI: 1.75–26.28). Using ROC curves, the ability of NT-proBNP to detect patients at risk was greater for heart failure, transplantation and death (AUC: 0.944; 95%CI: 0.900–0.988) than for all causes of hospitalisation (AUC: 0.8; 95%CI: 0.713–0.887). ConclusionIn systemic right ventricles, NT-proBNP is a useful risk predictor for all causes of hospitalisation and, in particular, for heart failure, transplantation and death. It therefore might be a useful tool for risk assessment in this patient population.

Re-evaluation of prognostic significance of NT-proBNP in a 5-year follow-up study assessing all-cause mortality in elderly patients (≥ 75 years) admitted to hospital due to suspect heart failure

BackgroundN-terminal pro-B-type natriuretic peptide (NT-proBNP) is a prognostic biomarker in heart failure (HF), especially in younger population. The prognostic value of NT-proBNP in an elderly HF population (≥75 years) remains less studied. The purpose of this study is to evaluate the prognostic value of NT-proBNP in patients aged≥75 years and admitted to hospital due to suspect HF with a median follow-up of 5 years. MethodsA prospective hospital cohort of 243 patients (82±4 years) who had NT-proBNP analyzed due to suspect HF during 2005–2007 was studied. ResultsAmong the study population, 75% had acute decompensated HF. Multivariable Cox proportional-hazard regression analysis and univariable Kaplan-Meier survival analysis demonstrated that NT-proBNP was not prognostic significant in HF cohort≥75 years old, and instead, pulmonary hypertension, history of valvular surgery and use of aldosterone receptor antagonist were significant prognostic indicators. However, subgroup analysis showed that in patients with NT-proBNP levels>8000 (ng/L), NT-proBNP is the only significant independent indicator for 5-year mortality whereas in patients with NT-proBNP≤8000(ng/L), enlargement of left atrium and pulmonary hypertension, instead of NT-proBNP, were significant prognostic indicators for mortality. ConclusionIn a HF population≥75 years old with acute decompensated HF, NT-proBNP was not significant prognostic indicator, except in a subgroup with NT-proBNP>8000 (ng/L). Therefore, the prognostic value of NT-proBNP in those HF patients≥75 years has to be interpreted with caution due to higher age and comorbidity.

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% vs 54.5%, p = 0.006) and cardiogenic shock (26.2% vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% vs 9.1%, p =0.021) and positive inotropics (35.71% vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.