Prognosis of stage A or B heart failure patients with elevated B-type natriuretic peptide levels.
BACKGROUND
Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients.


RESULTS
Outpatients referred for echocardiogram (n=829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62-2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11-3.28).


CONCLUSIONS
Individuals without any history of HF but with BNP >or=100pg/mL are at equal or higher risk than those with a HF history whose BNP is <100pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events.
Daniels
Lori B
LB
Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, CA, USA. lbdaniels@ucsd.edu
Clopton
Paul
P
Jiang
Kevin
K
Greenberg
Barry
B
Maisel
Alan S
AS
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain