Prognostic Value Of NT-proBNP Research Articles

NT-proBNP independently predicts long term mortality after acute exacerbation of COPD – a prospective cohort study

BackgroundCardiovascular disease is prevalent and frequently unrecognized in patients with chronic obstructive pulmonary disease (COPD). NT-proBNP is an established risk factor in patients with heart failure. NT-proBNP may also be released from the right ventricle. Thus serum NT-proBNP may be elevated during acute exacerbations of COPD (AECOPD). The prognostic value of NT-proBNP in patients hospitalized with AECOPD is sparsely studied. Our objective was to test the hypothesis that NT-proBNP independently predicts long term mortality following AECOPD.MethodsA prospective cohort study of 99 patients with 217 admissions with AECOPD. Clinical, electrocardiographic, radiological and biochemical data were collected at index and repeat admissions and analyzed in an extended survival analysis with time-dependent covariables.ResultsMedian follow-up time was 1.9 years, and 57 patients died during follow-up. NT-proBNP tertile limits were 264.4 and 909 pg/mL, and NT-proBNP in tertiles 1 through 3 was associated with mortality rates of 8.6, 35 and 62 per 100 patient-years, respectively (age-adjusted log-rank p<0.0001). After adjustment for age, gender, peripheral edema, cephalization and cTnT in a multivariable survival model, the corresponding hazard ratios for dying were 2.4 (0.95-6.0) and 3.2 (1.3-8.1) (with 95% confidence intervals in parentheses, p-value for trend 0.013).ConclusionsNT-proBNP is a strong and independent determinant of mortality after AECOPD.

NT-proBNP: A cardiac biomarker to assess prognosis in non-Hodgkin lymphoma

NT-proBNP provides diagnostic and prognostic information in heart syndromes but its role in cancer has not yet been established. The prognostic value of NT-proBNP was prospectively studied in 104 non-Hodgkin lymphoma (NHL) patients treated with chemotherapy. Echocardiography and NT-proBNP were determined prior to treatment. In multivariate analysis, NT-proBNP≥900pg/ml was the variable with higher risk of death (adjusted hazard ratio 11.1; 95% CI 3.8–32.9; P<0.001). The C statistic for NT-proBNP≥900pg/ml was significantly better than IPI score for prediction of survival. These findings suggest that NT-proBNP≥900pg/ml could be considered a useful marker for risk assessment in NHL patients treated with chemotherapy.

Prognostic value of NT-pro BNP, left ventricular inotropic reserve and cardiopulmonary exercise test in patients with non-ischemic dilated cardiomyopathy

Prognostic value of NT-pro BNP, left ventricular inotropic reserve and cardiopulmonary exercise test in patients with non-ischemic dilated cardiomyopathy

Prognostic Value of N-Terminal pro-B-Type Natriuretic Peptide in Patients With Acute Coronary Syndromes Undergoing Left Main Percutaneous Coronary Intervention

Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and December 2008 in whom NT-proBNP was measured (n=71). We analyzed the clinical characteristics and the short- and long-term outcomes in relation to NT-proBNP level at admission. Median NT-proBNP was 1,364 ng/L, ranging from 46 to 70,000 ng/L. NT-proBNP was elevated in 63 (89%) patients and was ≥1,000ng/L in 42 (59%). Log NT-proBNP (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.55-7.97, P=0.003) and left ventricular ejection fraction (HR 0.95, 95%CI 0.91-0.99, P=0.007) were predictors for all-cause mortality. Log NT-proBNP was the only independent significant predictor of cardiovascular mortality. In-hospital mortality was 0% for patients with NT-proBNP <1,000, but 17% for those with NT-proBNP ≥1,000 (P=0.036). NT-proBNP is a strong predictor of outcome in patients undergoing acute LM coronary artery stenting. Mortality in such patients is high, but those with NT-proBNP < 1,000ng/L may have a favorable short- and long-term prognosis. Further research, including a larger patient population, is needed to determine the optimal cut-off value for NT-proBNP in patients undergoing acute LM coronary artery intervention.

Amino-Terminal Pro–B-Type Natriuretic Peptide as Predictor of Mortality in Patients with Symptomatic Peripheral Arterial Disease: 5-Year Follow-Up Data from the Linz Peripheral Arterial Disease Study

Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as predictor of mortality endpoints in cardiac disease. In contrast, the prognostic value of NT-proBNP in patients with peripheral arterial disease (PAD) is unclear. Therefore, we aimed to evaluate the capability of NT-proBNP as a marker for long-term prognosis in atherosclerotic PAD. We obtained NT-proBNP serum concentrations in 487 consecutive patients with symptomatic PAD admitted to a tertiary-care hospital. The endpoint was defined as all-cause mortality, and the study participants were followed for 5 years. Of the 487 patients enrolled, 114 died and 373 survived during follow-up. The median NT-proBNP concentration was higher among decedents than survivors (692 vs 143 ng/L; P < 0.001). Using the median NT-proBNP concentration of the entire cohort (213 ng/L) as threshold level, Kaplan-Meier curve analysis demonstrated that the survival probability was lower in patients with NT-proBNP above the median (log-rank test, P < 0.001). In the fully adjusted Cox proportional-hazards regression analysis, NT-proBNP >213 ng/L had a risk ratio of 2.27 (95% CI 1.27-4.03; P = 0.005) independent of age, sex, glomerular filtration rate, clinical stage of PAD, cardiovascular comorbidity, and other potential confounders. Further analyses showed that NT-proBNP added significantly to the value of established and emerging outcome predictors of PAD. In this study, a NT-proBNP serum concentration >213 ng/L was a robust and independent predictor of 5-year all-cause mortality in patients with symptomatic PAD. Thus, NT-proBNP measurements can be considered a valuable tool for risk stratification in these patients.

Abstract 4496: Percutaneous Coronary Intervention in Stable Coronary Heart Disease: Value of Nt-Probnp for Stratification of Long-Term Risk

Purpose: N-terminal fragment of the B type-natriuretic peptide (NT-proBNP) is an established tool for assessing acute dyspnoea and stratifying risk in heart failure, acute coronary syndromes (ACS), and stable coronary heart disease (SCHD). The aim of this study was to determine the value of NT-proBNP in predicting long-term risk of patients (Pts) submitted to elective percutaneous coronary intervention (PCI) in the setting of SCHD. Methods: We prospectively studied 291 Pts (age 64.3±9.6 years, 64 female) with SCHD submitted to successful elective PCI, and determined NT-proBNP immediately before PCI. Pts were divided into 2 groups according to NT-proBNP level: group T3 formed by Pts with NT-proBNP level in the highest tertile and group T1+T2 formed by all remaining Pts. The study endpoint was time to the first occurrence of death (D) or non-fatal myocardial infarction (MI) during the mean follow-up of 568 ± 322 days. Multivariable analyses were performed to adjust the prognostic value of NT-proBNP for the effects of factors known to influence NT-proBNP (age, gender, renal function, body mass index) and of other potential predictors of outcome (cardiovascular risk factors, prior cardiovascular events, left ventricular ejection fraction, and PCI characteristics). Results: NT-proBNP ranged from 5 pg/ml to 104 pg/ml in the 1st tertile (T1), 105 pg/ml to 358 pg/ml in the 2nd tertile (T2), and 364 pg/ml to 33.991 pg/ml in the 3rd tertile (T3). During follow-up, 8 Pts died and 11 suffered a non-fatal MI. NT-proBNP was significantly higher in Pts who experienced an adverse outcome (440 pg/ml [inter-quartile range, 104 –1712] vs 174 pg/ml [inter-quartile range, 78 – 460) in Pts with uneventful follow-up; P= 0.007). An NT-proBNP level ≥364 pg/ml was associated with a higher endpoint rate (13.4% vs 3.1% in group T1+T2) and independently predicted outcome: adjusted hazard ratio 3.11, 95% CI, 1.15– 8.37, P=0.025. The sensitivity, specificity, predictive positive value, and negative predictive value for the criterion NT-proBNP ≥364 pg/ml were 68.4%, 69.1%, 13.4%, and 96.9%, respectively. Conclusion: In the setting of SCHD, the level of NT-proBNP is a powerful prognostic marker even after successful PCI.

Effect of Beta-blockade and ACE Inhibition on B-type Natriuretic Peptides in Stable Patients with Systolic Heart Failure

The long-term effect of beta-blockade on the plasma levels of natriuretic peptides BNP and its N-terminal counterpart, NT-proBNP, as risk markers in heart failure (HF) is obscure. Stable systolic HF patients from the CARMEN study were divided in groups matching their randomised treatment allocation: Carvedilol, enalapril or carvedilol+enalapril. Changes in BNP and NT-proBNP from baseline to 6 months maintenance visit were evaluated in each treatment arm. Furthermore, the prognostic value of BNP and NT-proBNP during monotherapy with carvedilol was assessed with univariate Cox proportional hazards models using a combined endpoint of all cause mortality and cardiovascular hospitalisation. NT-proBNP and BNP were significantly reduced after six months treatment with enalapril (NT-proBNP 1,303 to 857 pg/ml (P < 0.001), BNP 119 to 85 pg/ml (P < 0.001)) or carvedilol+enalapril (NT-proBNP 1,223 to 953 pg/ml (P = 0.003), BNP 117 to 93 pg/ml (P = 0.01)). In contrast, no change was observed in the carvedilol group (NT-proBNP 907 to 1,082 pg/ml (P = 0.06), BNP 114 to 130 pg/ml (P = 0.15). The prognostic value of NT-proBNP and BNP was maintained in the carvedilol group (NT-proBNP HR 1.018 95% CI (1.005-1.032), BNP 1.171 (1.088-1.260)). Treatment of HF patients with carvedilol alone does not reduce levels of natriuretic peptides, but treatment with enalapril does. Both BNP and NT-proBNP predict death and hospitalisation in HF patients treated with carvedilol for six months. The clinical implication of our results is that NT-proBNP and BNP can be used as risk markers of death and cardiovascular hospitalisations in systolic HF patients receiving carvedilol without ACE inhibition.

Prognostic value of NT-proBNP and big ET-1 in severe heart failure: significance of NT-proBNP and big ET-1 in cardiovascular diseases combining with severe heart failure

目的 探讨两检测指标血浆N末端B型钠尿肽原(NT-proBNP)和大内皮素-1(big ET-1)之间,两指标与心力衰竭(心衰)伴心房颤动(Af)、心衰伴肺动脉高压(PAH)等心血管病的关系,以及两指标对严重心衰患者半年期预后的预测价值.方法 阜外医院严重心衰患者132人,测定他们入院时的血浆LgNT-proBNP和big ET-1浓度(酶联免疫法)以及纽约心脏病协会心功能分级(NYHA分级)、左室射血分数(LVEF)等指标.随访观察患者出院后半年内心血管事件的再发生.结果 严重心衰患者132人(NYHA Ⅲ-Ⅳ级,年龄24～80岁,男83人,女49人,LVEF 13%～66%),其血浆LgNT-proBNP与big ET-1呈正相关(r=0.414,P=0.000).有、无Af的两组间big ET-1水平比较差异有统计学意义(P=0.022);有、无PAH的两组间LgNT-proBNP和big ET-1浓度差异均有统计学意义(P=0.019,P=0.000).以big ET-1诊断严重心衰患者伴PAH的ROC曲线下面积为0.74(95%CI:0.65～0.83,P=0.000),以4.09 fmol/ml为big ET-1诊断心衰伴PAH的cutoff值时,灵敏度为71.4%,特异度67.8%.经过6个月的随访,132例严重心衰患者中,有20例发生心源性死亡(15.2%),有25例因心脏原因再住院(18.9%).Cox比例风险模型分析显示,包括了年龄、性别、NYHA分级、LVEF、LgNT-proBNP、big ET-1等指标后,只有NT-proBNP是独立的心脏事件再发生的预后因素,RR为5.30(95%CI:2.07～13.55,P=0.001).Logistic回归显示也只有NT-proBNP是独立的心源性死亡发生的危险因素,OR为13.67(95%CI:2.59～72.25,P=0.002).big ET-1、LVEF、NYHA分级等指标对严重心衰患者心血管事件再发生没有预后价值.结论 NT-proBNP与big ET-1间可能存在相互作用;严重心衰伴Af的患者可能有内皮细胞损伤和功能异常;big ET-1可辅助诊断严重心衰患者伴发PAH;NT-proBNP可用于严重心衰患者半年期预后的评估,而big ET-1没有此预测价值。

Diagnostic Applications of Natriuretic Peptides in Ischemic Heart Disease

Early assessment of patients who have symptoms suggestive of an acute coronary syndrome (ACS) remains a challenge considering the heterogeneity of underlying pathologies and clinical outcomes. The purpose of the early evaluation of these patients is threefold: first, to diagnose or exclude acute myocardial infarction (AMI) second, to identify patients at different risks for future cardiac events; and third, to be able to select appropriate treatment. Currently the initial assessment of these patients is based on the patient’s history, clinical findings, ECG data, and serial testing of biochemical markers of myocardial necrosis, preferably troponin T or I. In the last few years, an increasing number of studies have evaluated the addition of the natriuretic peptides, NT-proBNP and BNP, in the diagnostic and prognostic arsenal for assessment of patients who have a suspected ACS. The studies of the value of natriuretic peptides have also been extended to patients who have stable angina pectoris for detection of significant coronary artery disease (CAD) and for assessment of the long-term risk. NT-proBNP and BNP in the different forms of ischemic heart disease The prognostic value of NT-proBNP and BNP has been evaluated in the full spectrum of ischemic heart disease in a large number of studies. It is striking that the increased mortality associated with elevation of NT-proBNP or BNP is of a similar degree, regardless of type of presentation of the ischemic heart disease.