title: Acute systolic heart failure with normal admission BNP: clinical features and outcomes.
abstract: BACKGROUND
  The characteristics and outcomes of patients hospitalized with acute systolic heart failure (HF) and normal admission B-type natriuretic peptide (BNP) has not been previously explored.
  
  
  METHODS
  Using the ESCAPE trial data, we compared patients with acute HF and left ventricular ejection fraction (LVEF) ≤30% who have either normal or elevated BNP on the day of hospitalization. The study endpoints were 30-day and 6-month mortality, all-cause rehospitalization and rehospitalization for HF.
  
  
  RESULTS
  Among 347 patients with acute systolic HF, 43 had normal (mean 50.6pg/mL) and 304 had elevated admission BNP (mean 1144pg/mL). Compared with patients with elevated BNP, those with normal admission BNP were younger (51.5 vs. 56.8years, P=0.01), with higher body mass index (33.6 vs. 28.7kg/m2, P<0.0001), lower frequency of ischemic etiology for heart disease (20.9% vs. 51.7%, P<0.001), lower blood urea nitrogen (29.1 vs. 36.3mg/dL, P=0.005) and creatinine (1.34 vs. 1.52mg/dL, P=0.038) levels, higher LVEF (25.5% vs. 19.1%, P=0.018), higher cardiac index (2.34 vs. 1.96, P=0.013), and better diastolic function evident by lower E/A ratio (1.73 vs. 2.67, P=0.001) and longer deceleration of E velocity (166 vs. 141ms, P=0.028). There was no difference between patients with normal or elevated admission BNP with regards to the degree of congestion. There were no differences between both groups in post-discharge hard endpoints such as 30-day (P=0.101) and 6-month (P=0.143) mortality, rehospitalization for any cause (P=0.992) or for HF (P=0.763).
  
  
  CONCLUSIONS
  Patients hospitalized with acute systolic HF and normal admission BNP had no significant differences in the degree of congestion and post-discharge outcomes compared with those with elevated BNP. A normal BNP in this instance was not valuable for diagnostic or prognostic purposes.
authors.affiliation: Internal Medicine Department, Mercy Medical Center, Clinton, Iowa, USA. Electronic address: hesham.omar@apogeephysicians.com.
authors.forename: Hesham R
authors.initials: HR
authors.lastname: Omar
authors.affiliation: Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Guglin
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010359:Patient Readmission / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Congestion; Heart failure; Mortality; Normal BNP; Rehospitalization