Direct comparison of transcardiac increase in brain natriuretic peptide (BNP) and N-terminal proBNP and prognosis in patients with chronic heart failure.
BACKGROUND
No previous study has compared the transcardiac gradient of cardiac natriuretic peptides and prognosis.


RESULTS
To compare the prognostic value of the transcardiac increase in brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in patients with chronic heart failure (CHF), the hemodynamic parameters and plasma levels of BNP and NT-proBNP were measured in the aortic root (AO) and coronary sinus (CS) in 353 consecutive patients with CHF. During a median follow-up of 2.8 years, 35 patients died. The molar ratio of (CS-AO) NT-proBNP to (CS-AO) BNP correlated with hemodynamic abnormalities and it was significantly higher in non-survivors than in survivors (median value=0.702 vs 0.437, respectively; p=0.0009), suggesting that NT-proBNP is superior to BNP in terms of transcardiac increase. After adjustment for clinical variables associated with CHF, including hemodynamics and an estimated glomerular filtration rate, it was found that only the plasma NT-proBNP level was an independent prognostic predictor, even after considering the transcardiac increases in BNP and NT-proBNP.


CONCLUSIONS
These findings suggest that the transcardiac gradient of NT-proBNP to BNP molar ratio increases with the severity of left ventricular dysfunction, and that plasma NT-proBNP level may be more useful than BNP for evaluating the prognosis of patients with CHF.
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan. tutamoto@belle.shiga-med.ac.jp
Takayoshi
T
Tsutamoto
Hiroshi
H
Sakai
Keizo
K
Nishiyama
Toshinari
T
Tanaka
Masanori
M
Fujii
Takashi
T
Yamamoto
Minoru
M
Horie
D000328:Adult; D000368:Aged; D001011:Aorta; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D054326:Coronary Sinus; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain