Incremental prognostic value of changes in B-type natriuretic peptide in heart failure.
OBJECTIVE
B-type natriuretic peptide is one of the most sensitive and specific biohumoral markers of heart failure. We hypothesized that B-type natriuretic peptide changes during treatment of heart failure may provide independent information on disease progression and outcome in patients enrolled in the Val-HeFT trial.


METHODS
Patients were divided into four groups according to concentrations of B-type natriuretic peptide at baseline versus 4 months (n = 3740) or 12 months (n = 3343), with respect to the baseline median (97 pg/mL): low-->low (stable below median, 44%-46%), high-->high (stable above median, 32%-37%), high-->low (above to below median, 12%-14%), and low-->high (below to above median, 6%-9%). Cox multivariate regression analysis was used to assess the risk of death and morbidity, with adjustment for baseline B-type natriuretic peptide concentrations.


RESULTS
Patients who improved their B-type natriuretic peptide at 4 months (high-->low) had a similar risk for mortality (hazard ratio = 1.191, 95% confidence interval [CI] 0.870-1.631, P =.2746) compared with the low-->low patients. Conversely, patients who worsened in their B-type natriuretic peptide (low-->high) had a risk for mortality (hazard ratio 2.578, CI, 1.861-3.571, P <.0001) higher than patients in the low-->low group, and indistinguishable from the high-->high group. Worsening of B-type natriuretic peptide (low-->high) was associated with 0.03 cm/m2 increase in left ventricular end-diastolic diameter, whereas it decreased by 0.10 cm/m2 in high-->low and low-->low groups (P <.001).


CONCLUSIONS
Changes in B-type natriuretic peptide over time with respect to a threshold value of 97 pg/mL convey an independent and additional prognostic value compared with a single determination of B-type natriuretic peptide in a large population of patients with chronic symptomatic heart failure and might be helpful in the management of these patients.
Latini
Roberto
R
Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. latini@marionegri.it
Masson
Serge
S
Wong
Maylene
M
Barlera
Simona
S
Carretta
Elisa
E
Staszewsky
Lidia
L
Vago
Tarciso
T
Maggioni
Aldo P
AP
Anand
Inder S
IS
Tan
Lip B
LB
Tognoni
Gianni
G
Cohn
Jay N
JN
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D004452:Echocardiography; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D015996:Survival Rate; D013777:Tetrazoles / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan
D047228:Angiotensin II Type 1 Receptor Blockers; D015415:Biomarkers; D013777:Tetrazoles; D020097:Natriuretic Peptide, Brain; D000068756:Valsartan; D014633:Valine