title: Distinguishable optimal levels of plasma B-type natriuretic peptide in heart failure management based on complicated atrial fibrillation.
abstract: A B-type natriuretic peptide (BNP)-guided strategy is being widely used as a superior management technique for heart failure (HF). However, the optimal target level of BNP to improve the prognosis of HF in clinical practice remains unclear. Several studies have recently demonstrated that the existence of atrial fibrillation (AF) affects plasma BNP levels. We evaluated the prognostic value of BNP assay for HF management and found the optimal target level under the BNP-guided HF management according to the basal cardiac rhythms: AF or sinus rhythm (SR). Patients hospitalized for HF exacerbation between 1996 and 2002 were stratified into SR (n = 129) and chronic AF (CAF, n = 58) groups as basal cardiac rhythms during hospitalization. Cardiac events including death and re-admission for HF exacerbation after discharge were analyzed in relation to the plasma BNP levels at predischarge. Receiver-operating characteristic (ROC) analysis demonstrated that the cut-off values for predischarge BNP, which predict cardiac events at 36 months after discharge, were 125 pg/mL in the SR group and 165 pg/mL in the CAF group. The area under the ROC curve was 0.72 and 0.82, respectively. Stratified subgroup analysis using the Kaplan-Meier method demonstrated that the risk of a cardiac event decreased in a stepwise fashion across a decreasing predischarge BNP range above these cut-off levels, while the minimum decreased risk was recognized at a BNP range below these cut-off levels in each group. In conclusion, the optimal target levels of plasma BNP at predischarge to improve the prognosis of HF should be different and distinguishable depending on with or without AF.
authors.affiliation: Department of Internal Medicine and Cardiology, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Koitabashi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inomata
authors.forename: Shinich
authors.initials: S
authors.lastname: Niwano
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Nishii
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takeuchi
authors.forename: Hironari
authors.initials: H
authors.lastname: Nakano
authors.forename: Hisahito
authors.initials: H
authors.lastname: Shinagawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takehana
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain