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European Journal of Heart Failure 2007 9(3):266-271; doi:10.1016/j.ejheart.2006.07.002
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© 2007 European Society of Cardiology

A change in N-terminal pro-brain natriuretic peptide is predictive of outcome in patients with advanced heart failure

Roy S. Gardnera,*, Kwok S. Chongb, James J. Mortonb and Theresa A. McDonaghc

a Department of Cardiology, Glasgow Royal Infirmary UK, 10 Alexandra Parade, Glasgow, G31 2ER, UK
b Division of Cardiovascular and Medical Sciences Western Infirmary, Glasgow, UK
c Department of Cardiology Royal Brompton Hospital, London, UK

* Corresponding author. Tel.: +44 211 4000; fax: +44 141 211 4950. E-mail address: rsgardner{at}doctors.org.uk


  Abstract

Background: The prognosis of chronic heart failure has improved with modern medical therapy. However, identifying those patients who fail to respond to such therapy and therefore those who remain at high risk is notoriously difficult. The B-type natriuretic peptides are established independent predictors of prognosis in CHF. However, the relevance of a change in NT-proBNP concentration over time in advanced heart failure is unknown.

Methods: We prospectively studied 133 patients with advanced CHF referred for consideration of cardiac transplantation. Plasma for NT-proBNP analysis was sampled at baseline and a median of 4months later in the 112 patients surviving without cardiac transplantation. Patients were followed up for a median of 1003days.

Results: The primary endpoint of all-cause mortality occurred in 30 (26.8%) patients. Those subjects who had the highest NT-proBNP concentration at 4months were at the greatest risk of death (log rank statistic=10.4, p=0.001). On Cox regression analysis, both a NT-proBNP concentration above the median and an absolute increase in NT-proBNP were independent predictors of mortality ({chi}2=53, p<0.0001 and {chi}2=17.3, p<0.0001, respectively).

Conclusion: A single NT-proBNP concentration above the median and a change in NT-proBNP concentration over a 4-month period were independent predictors of mortality in patients with advanced heart failure.

Key Words: Chronic heart failure • Prognosis • Transplantation • Natriuretic peptides

Received November 8, 2005; Revised June 6, 2006; Accepted July 10, 2006


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