Aminoterminal pro type B natriuretic peptide as a predictive and prognostic marker in patients with chronic heart failure.
BACKGROUND
B-type natriuretic peptide (BNP) is released from the cardiac ventricles in response to increased wall tension. We studied the relation of NT-proBNP to Heart Failure Survival Score (HFSS) and New York Heart Association (NYHA) class in patients with chronic heart failure (CHF). We also studied the impact for recipient selection for cardiac transplant and assessed it as a predictive and prognostic marker of CHF.


METHODS
A total of 550 patients with dilative cardiomyopathy (n = 323), and coronary artery disease (n = 227) were prospectively examined. All patients underwent spiroergometry, echocardiography, right heart catheterization, and electrocardiogram. Routine blood levels and NT-proBNP were measured. The clinical selection for cardiac transplant candidates was adjudicated by 2 independent cardiologists who were blinded to the results of NT-proBNP assays. Clinical outcome and predictive power of NT-proBNP were analyzed.


RESULTS
NT-proBNP levels in patients clinically considered for cardiac transplantation were significantly higher (2293 ng/ml vs 493 ng/ml; p < 0.001). The receiver operating characteristic (ROC) analysis regarding transplant candidacy showed an area under the ROC curve (AUC) of 0.84 +/- 0.01 for HFSS, 0.86 +/- 0.001 for NYHA, and 0.96 +/- 0.01 for NT-proBNP. Patients with increasing NT-proBNP levels or remaining elevated levels despite adequate heart insufficiency treatment were maintained with left ventricular assist device implantation (n = 10) or urgent heart transplantation (n = 2). Patients with NT-proBNP levels above 5000 pg/ml had a mortality rate of 28.4% per year. Twenty-eight patients died during the observation period; all these patients were within NYHA Classes 3 and 4 (NT-proBNP 5423 +/- 423 ng/ml).


CONCLUSIONS
NT-proBNP discriminates patients at high likelihood of being a candidate for transplantation and provides prognostic informations in patients with CHF. NT-proBNP levels above 5000 pg/ml at admission were associated with death, and these levels markedly discriminated candidates for left ventricular assist devices or urgent transplantation.
Department of Thoracic Surgery, University Hospital Muenster, Muenster, Germany. markus.rothenburger@ukmuenster.de
Markus
M
Rothenburger
Thomas
T
Wichter
Christof
C
Schmid
Jörg
J
Stypmann
Tonny D T
TD
Tjan
Elmar
E
Berendes
Christian
C
Etz
Aurélien
A
Pioux
Andreas
A
Löher
Frauke
F
Wenzelburger
Gabriele
G
Drees
Andreas
A
Hoffmeier
Gönter
G
Breithardt
Hans Heinrich
HH
Scheld
D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D018579:Patient Selection; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D013147:Spirometry
D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain