Effect of B-Type Natriuretic Peptide Level on Long-Term Outcome in Patients With End-Stage Heart Failure.
Previous studies have demonstrated elevated B-type natriuretic peptide (BNP) level indicates a poor outcome in patients with heart failure (HF). However, some patients with end-stage HF presented with low BNP level and the impact of the nearly "normal" BNP level on long-term outcome is not well understood. Our study aimed to evaluate the association of BNP level with long-term outcome in 218 consecutive patients with dilated cardiomyopathy and end-stage HF. Sixty-two patients (28%) presented with admission BNP level ≤400 pg/ml. During a median follow-up period of 20 months (4 to 26 months), the all-cause mortality rate in patients with BNP ≤400 pg/ml was higher than in patients with BNP >400 pg/ml (76% vs 48%, p <0.001). Patients were then divided into 5 groups according to the BNP level (≤400, 401 to 1,000, 1,001 to 2,000, 2,001 to 3,000, and >3,000 pg/ml), the all-cause mortality were 76%, 41%, 40%, 49%, and 75%, respectively (p <0.001). After multivariate adjustment, both BNP ≤400 and >3,000 pg/ml were independently associated with increased risk of all-cause mortality (hazard ratios 1.87, 95% CI 1.02 to 3.42, p = 0.043 and hazard ratio 2.31, 95% CI 1.16 to 4.60, p = 0.018, respectively). In conclusion, our present study demonstrated a "U-like" shape between BNP level and all-cause mortality in end-stage HF, and the seemingly "normal" BNP level might also be a risk factor for poor outcome. Low BNP level may be a reflection of impaired neurohormonal response or altered metabolism of BNP and is associated with increased risk of poor outcome.
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. Electronic address: huangbi120@163.com.
Bi
B
Huang
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Jian
J
Shen
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Lihua
L
Li
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Ying
Y
Huang
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Suxin
S
Luo
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain; D011379:Prognosis; D016016:Proportional Hazards Models
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain