Pro-B-type natriuretic peptide levels in acute decompensated heart failure.
OBJECTIVE
The present study sought to evaluate the clinical utility of pro-B-type natriuretic peptides (proBNP) in patients admitted with acute decompensated heart failure.


BACKGROUND
Plasma natriuretic peptides (BNP(1-)(32), N-terminal [NT]-proBNP(1-76)) have been demonstrated to assist in the diagnosis of patients with heart failure. However, the precursor to these polypeptides (proBNP(1-108)) circulates in plasma and may interfere with the measurement of currently used biomarkers.


METHODS
Plasma natriuretic peptides were assessed in 164 individuals (99% men) hospitalized with decompensated heart failure. The B-type natriuretic peptide (BNP), NT-proBNP, and proBNP levels at hospital admission and discharge were compared with the incidence of cardiac death and all-cause mortality within 90 days post-discharge.


RESULTS
Pro-B-type natriuretic peptides demonstrated a high degree of correlation with both BNP (R = 0.924, p < 0.001) and NT-proBNP (R = 0.802, p < 0.001) at admission. Further characterization of proBNP demonstrated little variation with changes in age, body mass index, creatinine, or systolic dysfunction. All 3 plasma natriuretic peptides were significantly elevated at admission in patients suffering a cardiac death or all-cause mortality (p < 0.05). Receiver-operating characteristic curves demonstrated that admission and discharge NT-proBNP (area under the curve [AUC] 0.788 and AUC 0.834) had superior prognostic power for all-cause mortality when compared with BNP (AUC 0.644, p < 0.01 and AUC 0.709, p < 0.01) and proBNP (AUC 0.653, p < 0.01 and AUC 0.666, p < 0.01) at the same time points.


CONCLUSIONS
Admission values of all natriuretic peptides can be used to predict cardiac death and all-cause mortality. A preliminary comparison suggests that discharge values of NT-proBNP have the greatest diagnostic yield for predicting these end points. Further studies should explore the synergistic prognostic potential of all natriuretic peptides.
Waldo
Stephen W
SW
University of California at San Diego, Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.
Beede
Jennifer
J
Isakson
Susan
S
Villard-Saussine
Sylvie
S
Fareh
Jeannette
J
Clopton
Paul
P
Fitzgerald
Robert L
RL
Maisel
Alan S
AS
D000208:Acute Disease; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain