European Journal of Heart Failure Advance Access originally published online on January 29, 2009
European Journal of Heart Failure 2009 11(4):367-377; doi:10.1093/eurjhf/hfp003
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The prognostic value of repeated measurement of N-terminal pro-B-type natriuretic peptide in patients with chronic heart failure due to left ventricular systolic dysfunction
Kubánek1,2,*
ra Lánská2
1 Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK
2 Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague 140 21, Czech Republic
* Corresponding author. Tel: +420 261365047, Fax: +420 261362986, Email: mikb{at}medicon.cz
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Abstract |
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Aims: Decreased N-terminal pro-B-type natriuretic peptide (NT-proBNP) during treatment of chronic heart failure (CHF) is associated with improved prognosis. However, there is lack of data from community-based HF programmes. We hypothesized that plasma levels of NT-proBNP, measured after optimization of pharmacotherapy in patients with CHF, may provide independent prognostic information when compared with baseline values and conventional prognostic markers.
Methods and results: N-terminal pro-B-type natriuretic peptide was measured in 354 patients with CHF and left ventricular ejection fraction <45%, who had recently been enrolled in a community-based HF programme. Patients underwent a 6 min walk test and clinical, echocardiographic and laboratory examinations. Pharmacotherapy was optimized; 318 patients survived until the second examination and measurement of NT-proBNP, which was performed between the 4th and 6th month of follow-up. During a median follow-up of 38.8 months, 125 patients died. Follow-up log NT-proBNP was a better predictor of death than either baseline log NT-proBNP or change in NT-proBNP (
2: 46.5 vs. 30.4 and 12.5, all P < 0.001). N-terminal pro-B-type natriuretic peptide was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalizations after baseline or follow-up assessment.
Conclusion: The measurement of NT-proBNP after optimization of pharmacotherapy provides stronger prognostic information than either the baseline value, the change in NT-proBNP, or other conventional methods of assessment.
Key Words: N-terminal pro-B-type natriuretic peptide • Prognosis • Chronic heart failure • Treatment monitoring • Community-based heart failure programme
Received October 13, 2008; Accepted November 19, 2008