© 2005 European Society of Cardiology
N-terminal brain natriuretic peptide is a more powerful predictor of mortality than endothelin-1, adrenomedullin and tumour necrosis factor-
in patients referred for consideration of cardiac transplantation
a The Scottish Cardiopulmonary Transplant Unit, Glasgow Royal Infirmary UK
b Division of Cardiovascular and Medical Sciences, Western Infirmary Glasgow, UK
c Department of Cardiology, Royal Brompton Hospital London, UK
* Corresponding author. The Scottish Cardiopulmonary Transplant Unit, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK. Tel.: +44 141 943 2310; fax: +44 141 211 4950. E-mail address: rsgardner{at}doctors.org.uk
 |
Abstract |
|---|
Background: The selection of patients for cardiac transplantation is notoriously difficult. We have demonstrated that N-terminal brain natriuretic peptide (NT-proBNP) is a powerful predictor of mortality in advanced heart failure and is superior to the traditional markers of chronic heart failure (CHF) severity. However, the comparative prognostic power of endothelin-1 (Et-1), adrenomedullin (Adm) and tumour necrosis factor-alpha (TNF-
) in this patient group is unknown.
Methods and results: We prospectively studied 150 consecutive patients with advanced CHF referred for consideration of cardiac transplantation. Blood samples for NT-proBNP, Et-1, Adm and TNF- analysis were taken at recruitment and patients followed up for a median of 666 days. The primary endpoint of all-cause mortality was reached in 25 patients and the secondary endpoint of all-cause mortality or urgent cardiac transplantation in 29 patients. The median values for NT-proBNP, Et-1, Adm and TNF- were 1494 pg/ml [interquartile range 530–3930], 0.39 fmol/ml [0.10–1.24], 94 pg/ml [54–207] and 2.0 pg/ml [0–18.5] respectively. The only univariate and multivariate predictor of all-cause mortality (
2=26.95, p<0.0001), or the secondary endpoint of all-cause mortality or urgent transplantation (2=31.23, p<0.0001), was an NT-proBNP concentration above the median value.
Conclusion: A single measurement of NT-proBNP in patients with advanced CHF can help identify patients at the highest risk of death, and is a better prognostic marker than Et-1, Adm and TNF-.
Key Words: Chronic heart failure • Prognosis • Neurohormones • Natriuretic peptides • Cardiac transplantation
Received April 12, 2004; Revised May 12, 2004; Accepted June 10, 2004
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Adlbrecht, M. Hulsmann, G. Strunk, R. Berger, D. Mortl, J. Struck, N. G. Morgenthaler, A. Bergmann, J. Jakowitsch, G. Maurer, et al. Prognostic value of plasma midregional pro-adrenomedullin and C-terminal-pro-endothelin-1 in chronic heart failure outpatients Eur J Heart Fail, April 1, 2009; 11(4): 361 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Gardner, K. S. Chong, E. O'Meara, A. Jardine, I. Ford, and T. A. McDonagh Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure Eur. Heart J., December 2, 2007; 28(24): 3027 - 3033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Olsson, K. Swedberg, J. G.F. Cleland, P. A. Spark, M. Komajda, M. Metra, C. Torp-Pedersen, W. J. Remme, A. Scherhag, P. Poole-Wilson, et al. Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a {beta}-blocker: Results from the Carvedilol Or Metoprolol European Trial (COMET) trial Eur J Heart Fail, August 1, 2007; 9(8): 795 - 801. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S. Chong, R. S. Gardner, J. J. Morton, E. A. Ashley, and T. A. McDonagh Plasma concentrations of the novel peptide apelin are decreased in patients with chronic heart failure Eur J Heart Fail, June 1, 2006; 8(4): 355 - 360. [Abstract] [Full Text] [PDF]
|
|