The prognostic value of repeated measurement of N-terminal pro-B-type natriuretic peptide in patients with chronic heart failure due to left ventricular systolic dysfunction.
OBJECTIVE
Decreased N-terminal pro-B-type natriuretic peptide (NT-proBNP) during treatment of chronic heart failure (CHF) is associated with improved prognosis. However, there is lack of data from community-based HF programmes. We hypothesized that plasma levels of NT-proBNP, measured after optimization of pharmacotherapy in patients with CHF, may provide independent prognostic information when compared with baseline values and conventional prognostic markers.


RESULTS
N-terminal pro-B-type natriuretic peptide was measured in 354 patients with CHF and left ventricular ejection fraction <45%, who had recently been enrolled in a community-based HF programme. Patients underwent a 6 min walk test and clinical, echocardiographic and laboratory examinations. Pharmacotherapy was optimized; 318 patients survived until the second examination and measurement of NT-proBNP, which was performed between the 4th and 6th month of follow-up. During a median follow-up of 38.8 months, 125 patients died. Follow-up log NT-proBNP was a better predictor of death than either baseline log NT-proBNP or change in NT-proBNP (chi(2): 46.5 vs. 30.4 and 12.5, all P < 0.001). N-terminal pro-B-type natriuretic peptide was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalizations after baseline or follow-up assessment.


CONCLUSIONS
The measurement of NT-proBNP after optimization of pharmacotherapy provides stronger prognostic information than either the baseline value, the change in NT-proBNP, or other conventional methods of assessment.
Kubánek
Milos
M
Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK. mikb@medicon.cz
Goode
Kevin M
KM
Lánská
Vera
V
Clark
Andrew L
AL
Cleland
John G F
JG
D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013599:Systole; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000150:complications* / Q000503:physiopathology
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain