title: Usefulness of clinical and NT-proBNP monitoring for prognostic guidance in destabilized heart failure outpatients.
abstract: OBJECTIVE
  To study the relative prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring in addition to clinical disease severity scores (CDSSs) in outpatients with destabilized heart failure (HF).
  
  
  RESULTS
  Seventy-one outpatients with recently destabilized HF were recruited. At baseline, and at all following visits, a CDSS based on Framingham criteria was obtained, and NT-proBNP levels were measured in a blind fashion. CDSS did not correlate with NT-proBNP levels at any time (P > 0.1), although their relative changes correlated during follow-up (P < 0.001). Forty patients (56%) had clinical events (cardiovascular death and/or HF hospitalization) within 1 year of follow-up. Changes in CDSS from baseline were not predictive of subsequent events (P > 0.1 for all visits), whereas changes in NT-proBNP levels were predictive at several time points: week 2 (P = 0.005), week 3 (P = 0.037), week 4 (P = 0.015), and 6 months (P = 0.026). A change in NT-proBNP levels at follow-up week 2 (%) added independent prognostic information (P < 0.001, HR 0.982, 95% CI 0.972-0.992) to baseline CDSS (P = 0.002, HR 2.05, 95% CI 1.290-3.266), age (P = 0.007, HR 1.034, 95% CI 1.009-1.059), and left ventricular ejection fraction (P = 0.013, HR 0.942, 95% CI 0.898-0.987).
  
  
  CONCLUSIONS
  Serial monitoring for per cent change in NT-proBNP concentrations offers superior prognostic information to clinical assessment among outpatients with recent destabilized HF.
authors.affiliation: Department of Cardiology, University Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, 30120 Murcia, Spain. dapascual@servicam.com
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual-Figal
authors.forename: Maite
authors.initials: M
authors.lastname: Domingo
authors.forename: Teresa
authors.initials: T
authors.lastname: Casas
authors.forename: Ignasi
authors.initials: I
authors.lastname: Gich
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordoñez-Llanos
authors.forename: Pedro
authors.initials: P
authors.lastname: Martínez
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010045:Outpatients; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain