title: Prognostic information provided by serial measurements of brain natriuretic peptide in heart failure.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) levels predict prognosis in heart failure patients. We aimed to evaluate if serial measurements of BNP can give additional prognostic information.
  
  
  METHODS
  Eighty-four patients with systolic dysfunction had two measurements of BNP with an interval of 8 to 12 months and were followed in order to register the occurrence of death. The study was observational and prospectively designed. During follow-up, patients were treated according to state of the art. Physicians were kept blind to BNP levels.
  
  
  RESULTS
  The median follow-up was 1190 days. The median initial BNP level was 260.4 pg/ml and decreased to 123 pg/ml in the second measurement (P=0.001). The decrease in BNP was significantly associated with ACE-i dosage and with the use of a beta-blocker. All-cause mortality was 20.2%. Patients whose initial BNP level was above the median had a significantly higher hazard of dying (HR 2.96, 95% CI 1.06-8.26). The same was observed for those whose BNP increased between the first and the second measurement (HR 2.64, 95% CI 1.00-7.00). In multivariable analysis, baseline BNP above the median and increasing BNP were associated with shorter survival.
  
  
  CONCLUSIONS
  Higher baseline BNP and the increasing levels during follow-up were independently associated with mortality. The decrease in BNP levels was proportional to ACE-i dosage and larger among patients on beta-blockers. These results confirm the prognostic information provided by BNP determination and suggest that serial measurements give additional prognostic information.
authors.affiliation: Department of Internal Medicine, Hospital de S. João, Porto, Unidade de I&D em Insuficiência Cardíaca do Porto, Porto, Portugal. pbettfer@esoterica.pt
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Paula
authors.initials: P
authors.lastname: Dias
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha-Gonçalves
authors.forename: António
authors.initials: A
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain