title: Beta-blockers influence the short-term and long-term prognostic information of natriuretic peptides and catecholamines in chronic heart failure independent from specific agents.
abstract: BACKGROUND
  In chronic heart failure (CHF), the physiologic effects of natriuretic peptides and catecholamines are interdependent. Furthermore, reports state an agent-dependent effect of individual beta-blockers on biomarkers. Data on the short-term and long-term predictive power comparing these biomarkers as well as accounting for the influence of beta-blocker treatment both on the marker or the resultant prognostic information are scarce.
  
  
  METHODS
  We included 513 consecutive patients with systolic CHF, measured atrial natriuretic peptide (ANP), N-terminal prohormone brain natriuretic peptide (NTproBNP), noradrenaline, and adrenaline, and monitored them for 90 +/- 25 months. Death or the combination of death and cardiac transplantation at 1 year, 5 years, and overall follow-up were considered end points.
  
  
  RESULTS
  Compared with patients not taking beta-blockers, patients taking beta-blockers had significantly lower levels of catecholamines but not natriuretic peptides. Only for adrenaline was the amount of this effect related to the specific beta-blocker chosen. Receiver operating characteristic curves demonstrated superior prognostic accuracy for NTproBNP both at the 1- and 5-year follow-up compared with ANP, noradrenaline, and adrenaline. In multivariate analysis including established risk markers (New York Heart Association functional class, left ventricular ejection fraction, peak oxygen uptake, and 6-minute walk test), of all neurohumoral parameters, only NTproBNP remained an independent predictor for both end points.
  
  
  CONCLUSIONS
  Long-term beta-blocker therapy is associated with decreased levels of plasma catecholamines but not natriuretic peptides. This effect is independent from the actual beta-blocker chosen for natriuretic peptides and noradrenaline. In multivariate analysis, both for short-term and long-term prediction of mortality or the combined end point of death and cardiac transplantation, only NTproBNP remained independent from established clinical risk markers.
authors.affiliation: Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Heidelberg, Germany. Lutz.Frankenstein@med.uni-heidelberg.de
authors.forename: Lutz
authors.initials: L
authors.lastname: Frankenstein
authors.forename: Manfred
authors.initials: M
authors.lastname: Nelles
authors.forename: Maxim
authors.initials: M
authors.lastname: Slavutsky
authors.forename: Dieter
authors.initials: D
authors.lastname: Schellberg
authors.forename: Andreas
authors.initials: A
authors.lastname: Doesch
authors.forename: Hugo
authors.initials: H
authors.lastname: Katus
authors.forename: Andrew
authors.initials: A
authors.lastname: Remppis
authors.forename: Christian
authors.initials: C
authors.lastname: Zugck
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002303:Cardiac Output, Low / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D002395:Catecholamines / Q000097:blood*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D002395:Catecholamines; D045265:Natriuretic Peptides; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain