The role of plasma biomarkers in acute heart failure. Serial changes and independent prognostic value of NT-proBNP and cardiac troponin-T.
OBJECTIVE
Brain natriuretic peptide (BNP), NT-proBNP and troponins are useful for the assessment of patients with heart failure. Few data exist about their serial changes and their prognostic value in patients with acute heart failure (AHF).


RESULTS
NT-proBNP and troponin-T plasma levels were measured at baseline, after 6, 12, 24, 48 h and at discharge in 116 consecutive patients with AHF and no evidence of acute coronary syndrome. NT-proBNP levels were 4421 pg/mL at baseline, declined after 24 h and reached their nadir at 48 h (2703 pg/mL). Troponin-T was detectable in 48% of patients. During a median follow-up of 184 days, 52 patients died or had a non-fatal cardiovascular hospitalisation. At a multivariable analysis including clinical and echo-Doppler variables, NT-proBNP plasma levels at discharge, detectable troponin-T plasma levels, and NYHA class at discharge were the only independent prognostic factors.


CONCLUSIONS
In patients with AHF, NT-proBNP levels decline 24 h after the initiation of intravenous therapy and troponin-T is detectable in 48% of cases. NT-proBNP levels at discharge, detectable troponin-T levels, NYHA class and serum sodium have independent prognostic value.
Metra
Marco
M
Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy. metramarco@libero.it
Nodari
Savina
S
Parrinello
Giovanni
G
Specchia
Claudia
C
Brentana
Loretta
L
Rocca
Patrizia
P
Fracassi
Francesco
F
Bordonali
Tania
T
Milani
Patrizia
P
Danesi
Rossella
R
Verzura
Giulia
G
Chiari
Ermanna
E
Dei Cas
Livio
L
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain