Single measurement of serum N-terminal pro-brain natriuretic peptide: the best predictor of long-term mortality in patients with chronic systolic heart failure.
BACKGROUND
Although high serum natriuretic peptide (NP) has long been associated with mortality prediction, it was usually tested under acute heart failure (HF) conditions and periods of analysis were short. This may explain the lack of consensus when its routine measurement for mortality prediction is contemplated. Here we evaluated, at the first clinic visit of chronic systolic HF patients, the usefulness of a single serum NP assessment for long-term mortality prediction.


METHODS
In 279 consecutive patients with chronic systolic HF, serum NT-proBNP was routinely measured once during the first clinic visit. We analyzed correlations between recorded mortality and the NT-proBNP finding, along with several known clinical echocardiographic, electrocardiographic and laboratory parameters recorded at that visit.


RESULTS
During average follow-up of 34±21months 59 (21%) patients died. Serum NT-proBNP was the strongest of the tested predictors of mortality [hazard ratio 3.76, 95% Cl (1.20-11.80), p=0.008]. Nearly seven years later, mortality was still higher in patients with higher initial serum NT-proBNP (p<0.001).


CONCLUSIONS
Compared to many other traditional prognostic parameters tested at the same time, the single serum NT-proBNP finding was the strongest predictor of long-term mortality. These results may justify its routine use for this purpose.
The Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Roni
R
Berin
Heart Failure Unit, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Lin Medical Center, Haifa, Israel; Heart Failure Clinic, Lin Medical Center, Haifa, Israel.
Barak
B
Zafrir
Heart Failure Clinic, Lin Medical Center, Haifa, Israel; Cardiovascular Department, Poriya Medical Center, Tiberius, Israel.
Nabeeh
N
Salman
Heart Failure Clinic, Lin Medical Center, Haifa, Israel; Cardiovascular Department, Poriya Medical Center, Tiberius, Israel. Electronic address: offeram@012.net.il.
Offer
O
Amir
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D014463:Ultrasonography
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Natriuretic peptides; Risk stratification; Systolic Heart Failure