title: How often we need to measure brain natriuretic peptide (BNP) blood levels in patients admitted to the hospital for acute severe heart failure? Role of serial measurements to improve short-term prognostic stratification.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) is increasingly used in the management of patients with heart failure (HF). It is still unclear how to use serial BNP measurement in HF.
  
  
  OBJECTIVE
  To evaluate the usefulness of three consecutive measurements of BNP in patients (pts) hospitalized for acute HF.
  
  
  METHODS
  Clinical evaluation, BNP levels and echocardiography were assessed in 150 pts (67% males, age: 69+/-12 years; left ventricular ejection fraction: 34+/-14%) admitted for severe HF (NYHA class III-IV: 146/150). BNP measurements were obtained: at admission (basal, T0), at discharge (T1) and at first ambulatory control (T2), after optimization of medical therapy in those with discharge BNP level >250 pg/mL. End-points were death and hospital readmission during 6-month follow-up.
  
  
  RESULTS
  According to BNP levels 3 groups of patients were identified: Group 1 (62 pts, 41%), in whom discharge (T1) BNP was high and persisted elevated at T2 despite aggressive medical therapy; at 6-month follow-up 72% died or were hospitalized for HF. Group 2 (36 pts, 24%), in whom discharge (T1) BNP was high but decreased after medical therapy (T2); death and HF-readmission were observed in 8 pts (26%). Group 3 (52 pts, 35%), in whom discharge (T1) BNP levels were <250 pg/mL and persisted below this value at T2; death and HF-hospital readmission were observed in 6 pts (12%). Event rate differences among groups were statistically significant (p<0.001). At Cox-analysis discharge BNP cutoff of 250 pg/mL was the only parameter predictive of a worse outcome.
  
  
  CONCLUSIONS
  These data suggest that 3 BNP measurements, at admission, at discharge and few weeks later can allow to identify HF pts whom, despite a further potentiation of medical therapy, will present a worsening or even will die during short-term follow-up.
authors.affiliation: Dept. of Cardiology, Spedali Civili and University of Brescia, Brescia, Italy. faggiano@numerica.it
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.forename: Sabrina
authors.initials: S
authors.lastname: Barro
authors.forename: Prospero
authors.initials: P
authors.lastname: Giovinazzo
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas