Value Of NT-proBNP In Patients Research Articles

Prognostic utility and cutoff differences of NT-proBNP level across subgroups in heart failure with preserved ejection fraction: Insights from the PURSUIT-HFpEF Registry

ObjectivesN-terminal pro brain natriuretic peptide (NT-proBNP) is a biomarker for myocardial stress used in diagnosing and prognosticating heart failure (HF). However, its interpretation is complicated by clinical factors. This study aims to clarify the prognostic value of NT-proBNP in patients with heart failure with preserved ejection fraction (HFpEF), and risk-prediction cutoffs considering various clinical factors. MethodsThe study utilized data of prospective multicenter observational Asian HFpEF registry. Patients with acute decompensated HF and left ventricular ejection fraction ≥ 50% were included. NT-proBNP levels were measured at discharge. The primary endpoint was a composite of all-cause death and hospitalization for HF within 1 year after discharge. ResultsA total of 1,231 patients (83 [77, 87] years, 551 (45%) male) were enrolled, with 916 eligible patients analyzed. The median NT-proBNP level was 1,060 pg/m. In multivariable logistic regression model, NT-proBNP was significantly associated with the primary endpoint (adjusted OR for log-transformed NT-proBNP:2.71, 95%CI:1.78-4.18, p<0.001). Subgroup analysis revealed varying NT-proBNP distributions and differential safety cutoffs (329-929 pg/mL) at sensitivity of 0.8 based on factors like atrial fibrillation and chronic kidney disease, maintaining its discriminatory performance (Area under the curve: 0.587-0.734). ConclusionsNT-proBNP at discharge is a significant prognostic marker for HFpEF. Although NT-proBNP showed different distributions in various subgroups and cutoff values were distinctive for each, the prognostic utility was found to be equivalent in almost all subgroups with similar moderate discriminative performance. The study highlights the necessity of personalized NT-proBNP cutoffs for better management and prognostication of HFpEF.

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 (&amp;lt;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&amp;lt;0.001] and at discharge [480 (107;1406) pg/ml, 1077 (250;1649) pg/ml, 1685 (628;2733) ) pg/ml, respectively, p&amp;lt;0.001]. In patients with NAFLD and ADHF, according to multivariate Cox regression analysis, NTproBNP level &amp;gt;1593 pg/ml at discharge (hazard ratio (HR) 3.14; 95% confidence interval (CI) 1.52– 6.43; p&amp;lt;0.001) and LVEF&amp;lt;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.

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.

N-Terminal Pro Brain Natriuretic Peptide in Assessment of Severity of Coronary Artery Disease in Patients with Non ST Elevation Acute Coronary Syndrome

Introduction: N-Terminal pro Brain Natriuretic Peptide (NT-pro BNP) is an important biomarker in the management of patients with heart failure. Several studies reported its importance as a predictor of morbidity and mortality in Acute Coronary Syndrome (ACS) patients. Aim: To compare serum NT-proBNP levels in Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients and controls and to assess the relation between Nt-proBNP and the severity of Coronary Artery Disease (CAD) in patients with NSTE-ACS including unstable Angina (UA) and Non ST Elevation Myocardial Infarction (NSTEMI). Materials and Methods: Sixty NSTE-ACS patients and 20 matched control without significant obstructive CAD were included in the study. Cardiac enzymes, blood urea, serum creatinine, serum NT-proBNP were measured in all patients immediately before coronary angiography. Gensini score and Syntax score were calculated for all study patients. The NSTE-ACS patients were followed-up for six months for Major Adverse Cardiovascular Events (MACE) including mortality, myocardial infarction, heart failure, stroke, revascularisation by primary percutaneous coronary intervention or Coronary Artery Bypass Grafting (CABG). Results: The mean serum NT-proBNP in NSTE-ACS (UA and NSTEMI) patients was significantly higher (662.7±635.2) pg/mL than that in the control (102.3±96.4) pg/mL, p&lt;0.001. The effective cut-off value for the diagnosis of CAD was 139 pg/mL, Area Under Curve (AUC)=0.950, 95% CI: 0.890-1.00). The serum NT-proBNP was correlated with the severity and complexity of CAD as measured by Gensini score (r=0.496, p&lt;0.001) and Syntax score (r=0.443, p&lt;0.001). The mean value of NT-proBNP in patients with six months MACE was insignificantly higher than in patients without six months MACE with Interquartile Range (IQR) of 418.5 (139-2037) vs. 366 (175-3237) pg/mL, p=0.970. Conclusion: NT-proBNP was correlated with the severity and complexity of CAD in NSTE-ACS with preserved left ventricular systolic function, but it has no impact on six months MACE.

Prognostic Value of NT-proBNP and an Adapted Monin Score in Patients With Asymptomatic Aortic Stenosis

Introduction and objectivesOur objective was to assess the prognostic value of NT-proBNP in patients with asymptomatic moderate/severe aortic stenosis and to validate an adapted Monin score using natriuretic peptide levels in our setting. MethodsProspective study of 237 patients with degenerative asymptomatic moderate/severe aortic stenosis. NT-proBNP was determined in all patients, who were then followed up clinically. The adapted Monin score was defined as follows: (peak velocity [m/s]×2)+(logn NT-proBNP×1.5)(+1.5 if woman). A clinical event was defined as surgery, hospital admission due to angina, heart failure or syncope, or death. ResultsA total of 51% were women, and the mean age was 74 years. Mean (SD) echocardiographic values were as follows: peak velocity 4.14 (0.87) m/s; mean gradient, 43.2 (16.0) mmHg; aortic valve area, 0.87 (0.72) cm2, and aortic valve area index, 0.49 (0.14) cm2/m2. The median NT-pro-BNP value was 490.0 [198.0-1312.0] pg/mL. There were 153 events during follow-up (median 18 months). The optimum NT-proBNP cut-point was 515 pg/mL, giving event-free survival rates at 1 and 2 years of 93% and 57%, respectively, in patients with NT-proBNP <515 pg/mL compared with 50% and 31% in those with NT-proBNP >515 pg/mL. Patients were divided into quartiles based on the Monin score. Event-free survival at 1 and 2 years was 87% and 79% in the first quartile, compared with 45% and 28% in the fourth quartile, respectively. ConclusionsNT-proBNP determination provides prognostic information in patients with asymptomatic moderate/severe aortic stenosis. The adapted Monin score is useful in our setting and allows a more precise prognosis than does the use of NT-proBNP alone.

Valor pronóstico de la NT-proBNP y adaptación de la puntuación de Monin en pacientes con estenosis aórtica asintomática

Introduction and objectivesOur objective was to assess the prognostic value of NT-proBNP in patients with asymptomatic moderate/severe aortic stenosis and to validate an adapted Monin score using natriuretic peptide levels in our setting. MethodsProspective study of 237 patients with degenerative asymptomatic moderate/severe aortic stenosis. NT-proBNP was determined in all patients, who were then followed up clinically. The adapted Monin score was defined as follows: (peak velocity [m/s]×2)+(logn NT-proBNP×1.5)(+1.5 if woman). A clinical event was defined as surgery, hospital admission due to angina, heart failure or syncope, or death. ResultsA total of 51% were women, and the mean age was 74 years. Mean (SD) echocardiographic values were as follows: peak velocity 4.14 (0.87) m/s; mean gradient, 43.2 (16.0) mmHg; aortic valve area, 0.87 (0.72) cm2, and aortic valve area index, 0.49 (0.14) cm2/m2. The median NT-pro-BNP value was 490.0 [198.0-1312.0] pg/mL. There were 153 events during follow-up (median 18 months). The optimum NT-proBNP cut-point was 515 pg/mL, giving event-free survival rates at 1 and 2 years of 93% and 57%, respectively, in patients with NT-proBNP <515 pg/mL compared with 50% and 31% in those with NT-proBNP >515 pg/mL. Patients were divided into quartiles based on the Monin score. Event-free survival at 1 and 2 years was 87% and 79% in the first quartile, compared with 45% and 28% in the fourth quartile, respectively. ConclusionsNT-proBNP determination provides prognostic information in patients with asymptomatic moderate/severe aortic stenosis. The adapted Monin score is useful in our setting and allows a more precise prognosis than does the use of NT-proBNP alone.Full English text available from:www.revespcardiol.org/en

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.

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.

Clinical value of NT-proBNP in the diagnosis and analysis of correlation of NT-proBNP with clinical and echocardiographic findings in patients with aortic stenosis

To evaluate the diagnostic value of NT-proBNP in patients with aortic stenosis (AS), analyze the relation of NT-proBNP to NYHA functional class and echocardiographic findings. Measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay in 40 aortic stenosis patients (AS group) and 76 normal subjects (control group). We assessed the diagnostic value of NT-proBNP for aortic stenosis, and related NT-proBNP to clinical NYHA functional class and echocardiographic findings. Compared to controls, NT-proBNP levels had significantly higher in patients with aortic stenosis (P < 0.01). The level of NT-proBNP was gradually and significantly increased with the NYHA functional II, III and IV class compared to controls (all P < 0.01). NT-proBNP was significantly (3.5 times) higher in mild/moderate stenosis group than that in control group (2.95 ± 0.48 vs 2.63 ± 0.10, P < 0.05), and was significantly (6.0 times) higher in severe stenosis group than that in control group (3.16 ± 0.50 vs 2.63 ± 0.10, P < 0.01). LVMI was significantly (1.7 times) higher in mild/moderate stenosis group than that in control group (169 ± 51 vs 100 ± 22, P < 0.01), and was significantly (2.1 times) higher in severe stenosis group than that in control group (212 ± 86 vs 100 ± 22, P < 0.01). The NT-proBNP values of 1150 ng/L and 1356 ng/L were determined as the best cutoff values for the diagnosis of patients with mild/moderate (AUC = 0.657, P < 0.05) and severe aortic stenosis (AUC = 0.848, P < 0.01), the sensitivity, specificity and accuracy were 61.11% and 77.30%, 69.74% and 96.10%, 68.09% and 91.80%. Log (NT-proBNP) was significantly positively related with LVEDD, LVMI and mean transvalvular pressure gradient (MTPG) (all P < 0.05), and negatively related with LVEF (P = 0.01) in univariate analysis. In multiple regression analyses, NYHA functional class, LVEF and Log (MTPG) was independently associated with NT-proBNP. NT-proBNP is valuable for the diagnosis of patients with aortic stenosis. NT-proBNP has correlation with the heart function and severity of the aortic stenosis.

Serum levels of NT-proBNP as surrogate for cardiac amyloid burden: new evidence from gadolinium-enhanced cardiac magnetic resonance imaging in patients with amyloidosis

Background. The prognostic value of NT-proBNP has been recognized in patients with amyloidosis complicated by cardiac involvement. We aimed to use contrast enhanced cardiac magnetic resonance imaging (CMR) to identify functional and structural alterations related to levels of NT-proBNP better to understand the mechanisms of its release in cardiac amyloidosis.Methods and Results. CMR was performed on a 1.5-T scanner in 34 patients with biopsy proven amyloid light chain (AL; n = 27) or hereditary transthyretin related (TTR; n = 7) amyloidosis. NT-proBNP was higher in patients with (n = 25) compared to patients without cardiac involvement (n = 9) (2931 (IQR: 972–8629; min-max: 25–27,277) pg/ml vs. 177 (IQR: 71–1431; min-max: 22–7935) pg/ml, p = 0.008). ROC analysis identified a NT-proBNP of <2426.5 pg/ml as optimal discriminator for event free survival (682 ± 65 days). NT-proBNP did not correlate with LV- ejection fraction, end-diastolic and end-systolic volumes or stroke volume. There was a moderate correlation between NT-proBNP and LV-mass (R = 0.52, p = 0.003) and extent of late gadolinium enhancement (LGE; R = 0.41, p = 0.04).Conclusions. This study confirms the prognostic value of NT-proBNP in patients with AL and TTR amyloidosis and provides the novel finding that NT-proBNP correlates with surrogates of myocardial amyloid burden such as LV-mass and LGE, supporting the concept of NT-proBNP as a biomarker reflecting the severity of cardiac amyloid infiltration.

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.

Diagnostic and prognostic value of N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with chronic aortic regurgitation

Background BNP and its N-terminal fragment NT-proBNP have proven to be of diagnostic and prognostic value in patients with valvular aortic stenosis. Data regarding those biomarkers in patients with chronic aortic regurgitation (AR) are sparse. Thus it was the aim of the present study to evaluate the diagnostic and the long term prognostic value of NT-proBNP in patients presenting with AR. Methods and results This study included 60 patients with isolated AR of varying severity (AR I mild, AR II moderate and AR III severe) and preserved left ventricular function. Patients were followed over a median period of 824 (770–921) days. NT-proBNP at baseline was related to disease severity and to functional status (161 (70–456) pg/ml in AR I, 226 (100–666) pg/ml in AR II and 1268 (522–5446) pg/ml in AR III ( p = 0.003)). Patients ( n = 6) experiencing an adverse event had higher NT-proBNP values at baseline as event free survivors (1271 (613–2992) pg/ml vs. 215 (92–534) pg/ml; p = 0.034). The AUC of the ROC curve for NT-proBNP as a predictor for an adverse event was 0.76 ( p < 0.036) with an optimised cut-off value of 602 pg/ml. Consequently, in Kaplan–Meier analysis NT-proBNP values dichotomised at this cut-off were able to discriminate patients with an adverse outcome in the entire study group (Log rank 9.98, p = 0.0016) and even better in the conservative group (Log rank 26.92, p < 0.001). Conclusion NT-proBNP is linked to disease severity in patients with chronic aortic regurgitation reflecting hemodynamic stress due to volume overload. It provides prognostic information for the clinical outcome and thus might be a useful biomarker for risk stratification.

Prognosis of decompensated heart failure patients with preserved systolic function is predicted by NT-proBNP variations during hospitalization

Background Almost half of heart failure (HF) patients have preserved left ventricular systolic function (LVSF). Although morbidity is similar in patients with preserved and depressed LVSF, clinicians have limited information on prognostic factors of patients with preserved LVSF. We aimed to evaluate the prognostic value of NT-proBNP in patients with decompensated HF regardless of LVSF. Methods Patients hospitalised due to decompensated HF were followed for 6 months. The primary endpoint was death or hospital readmission. We evaluated 224 patients with NT-proBNP measured at admission and discharge and an echocardiogram performed. NT-proBNP decreased on average during hospitalization in patients with preserved LVSF ( n = 63) and in patients with depressed LVSF ( n = 161). The morbidity was not different between patients with preserved and depressed LVSF. Among patients with preserved LVSF, predictors of adverse events were serum creatinine, haemoglobin, NT-proBNP levels at discharge and the variation in NT-proBNP during hospitalisation. Among patients with depressed LVSF, predictors of adverse events were female gender, atrial fibrillation, non-prescription of ACE-inhibitor at discharge, NT-proBNP levels at discharge and the variation in NT-proBNP during hospitalisation. Conclusions These results suggest that, in HF patients with preserved LVSF as in patients with depressed LVSF, NT-proBNP can play a role as a tool to identify patients at risk of an adverse outcome.