© 2007 European Society of Cardiology
Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a β-blocker: Results from the Carvedilol Or Metoprolol European Trial (COMET) trial
a Department of Emergency and Cardiovascular Medicine Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
b University of Hull, Kingston upon Hull, United Kingdom
c Nottingham Clinical Research Group, Nottingham, United Kingdom
d Department of Cardiology, La Pitié-Salpétrière Hospital, Paris France
e Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy
f Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
g Sticares Cardiovascular Research Institute, Rhoon, The Netherlands
h Medical Clinic, University Hospital Mannheim, University of Heidelberg, Germany
i National Heart and Lung Institute, Imperial College, London, United Kingdom
* Corresponding author. Department of Medicine, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden. Tel.: +46 313434078; fax: +46 31258933. E-mail address: karl.swedberg{at}gu.se
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Abstract |
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Background: Plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP) are increased in patients with chronic heart failure (CHF). Beta-blockers (BB) may influence these levels but it is unclear whether changes in NT-pro BNP reflect concomitant changes in prognosis.
Objectives: To assess the prognostic importance of NT-pro BNP at baseline and during follow-up, in patients in whom beta-blocker therapy is initiated.
Methods: In COMET, 3029 patients with CHF in NYHA class II–IV and EF<35% were randomised to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Blood samples were collected for the measurement of NT-pro BNP at baseline (n=1559) and during follow-up (n=309).
Results: Baseline plasma concentrations of NT-pro BNP above the median (1242 pg/ml) were associated with higher all-cause mortality (RR 2.77; 95% CI 2.33–3.3, p<0.001). Patients who achieved NT-pro BNP levels <400 pg/ml during follow-up had a lower subsequent mortality (RR 0.32; 95% CI 0.15–0.69, p=0.004).
Conclusions: The plasma concentration of NT-pro BNP is a powerful predictor of mortality in patients with CHF. Patients who achieve an NT-pro BNP of <400 pg/ml subsequent to treatment with a beta-blocker have a favourable prognosis.
Key Words: Chronic heart failure • Natriuretic peptides • Prognosis • Treatment
Received January 24, 2007; Revised February 27, 2007; Accepted July 5, 2007
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