© 2008 European Society of Cardiology
Prognostic value of sequential measurements of amino-terminal prohormone of B-type natriuretic peptide in ambulatory heart failure patients
Department of Cardiology, Medical University of Vienna Waehringer Guertel 18-20, A-1090 Vienna, Austria
* Corresponding author. Tel.: +43 1 40400 4614; fax: +43 1 40400 4216. E-mail address: deddo.moertl{at}meduniwien.ac.at (D. Moertl).
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Abstract |
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Background: We evaluated the prognostic value of sequential NT-proBNP values in ambulatory heart failure patients after discharge, investigating whether the current value or the recent percent change is more important.
Methods and results: In 166 patients, NT-proBNP was measured at discharge from heart failure hospitalisation and three months later. The combined endpoint of death or heart failure rehospitalisation was evaluated after a maximum of 18 months or at follow-up closure. During a mean observation time of 14±4 months, 63 patients (38%) reached the endpoint. In multiple Cox analysis, NT-proBNP three months after discharge (NT-proBNP-3Mo) and NT-proBNP percent change (NT-proBNP-%change) were the only independent predictors of the endpoint among various clinical and laboratory variables. After definition of a high- (n = 83, 57% endpoints) and a low-NT-proBNP patient subgroup (n = 83, 19% endpoints) according to the median NT-proBNP-3Mo (1751 pg/ml), NT-proBNP-%change was the strongest predictor in the high-NT-proBNP subgroup. In the low-NT-proBNP subgroup, NT-proBNP-3Mo was the only independent predictor.
Conclusions: In ambulatory heart failure patients, the prognostic value of sequential NT-proBNP measurements depends on the magnitude of the current NT-proBNP value. Recent percent changes in NT-proBNP provide important prognostic information in patients with high NT-proBNP but not in patients with low NT-proBNP.
Key Words: Chronic heart failure • Prognosis • Natriuretic peptides
Received May 1, 2007; Revised December 18, 2007; Accepted February 28, 2008
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