title: NT-proBNP, IGF-I and survival in patients with chronic heart failure.
abstract: OBJECTIVE
  Growth hormone (GH) resistance with a reduction of insulin-like growth factor-I (IGF-I) serum concentrations seems to be implicated in the catabolic process associated with chronic heart failure (CHF). However, data concerning the prognostic value of these alterations in CHF patients without cachexia are scant. In this study, we aimed to determine in CHF patients the prognostic value of IGF-I/GH ratio and its relationships with N-terminal brain natriuretic peptide (NT-proBNP), a known marker of prognosis in these patients.
  
  
  METHODS
  We enrolled 82 non-cachectic patients, mean age 61+/-13 years, with ejection fraction <40% and predischarge New York Heart Association (NYHA) functional classes II-IV. All patients underwent clinical examination, two-dimensional echocardiography and NT-proBNP, GH and IGF-I measurement with log IGF-I/GH ratio calculation. Mortality and clinical status was documented at follow-up (18.4+/-8.1 months).
  
  
  RESULTS
  During follow-up 17 patients died of cardiac causes. Non-survivors were at baseline in higher NYHA class (P<0.05) and showed higher values of NT-proBNP (P<0.001) than survivors; differently IGF-I, and log IGF-I/GH ratio were lower (P<0.05). At Cox multivariate analysis, NT-proBNP (P<0.001) and IGF-I/GH ratio (P<0.05) were independent predictors of death.
  
  
  CONCLUSIONS
  High NT-proBNP levels and low IGH-I/GH ratio may be useful to stratify CHF patients at higher risk of cardiac death.
authors: Department of Internal Medicine, Cardiology, Heart and Immunological Sciences, Section of Internal Medicine, University of Naples Federico II, Italy.
authors: Mario
authors: M
authors: Petretta
authors: Annamaria
authors: A
authors: Colao
authors: Celestino
authors: C
authors: Sardu
authors: Franco
authors: F
authors: Scopacasa
authors: Paolo
authors: P
authors: Marzullo
authors: Rosario
authors: R
authors: Pivonello
authors: Luca
authors: L
authors: Fontanella
authors: Maurizio
authors: M
authors: de Caterina
authors: Adriano
authors: A
authors: de Simone
authors: Domenico
authors: D
authors: Bonaduce
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D019282:Wasting Syndrome / Q000175:diagnosis / Q000209:etiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D007334:Insulin-Like Growth Factor I