© 2005 European Society of Cardiology
A direct comparison of the natriuretic peptides and their relationship to survival in chronic heart failure of a presumed non-ischaemic origin
a McMaster University, St. Joseph's Hospital 50 Charlton Avenue East, Hamilton, ON, Canada L8N 4A6
b Faculty of Medicine, Division of Cardiology, University Health Network, Toronto General Hospital Canada
c Cardiology Fellow, Faculty of Medicine, University of Toronto Canada
d SYN·X Pharma Inc. Toronto, Canada
e Research Institute for Internal Medicine, Faculty of Medicine, University of Oslo Norway
f Searle Chair in Cardiovascular Research Canada
* Corresponding author. Tel.: +1 905 521 6058; Fax: +1 905 521 6068. E-mail address: stantone{at}mcmaster.ca
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Abstract |
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The natriuretic peptides have been validated as sensitive and specific markers of left ventricular dysfunction; brain natriuretic peptide (BNP), N-terminal atrial natriuretic peptide (NT-proANP) and N-terminal brain natriuretic peptide (NT-proBNP) elevations have been associated with New York Heart Association (NYHA) Class I–IV heart failure. We directly compared the association of each of these markers with 1-year survival in 173 patients with chronic heart failure of a presumed nonischaemic origin entering the PRAISE-2 Trial, a clinical study which assessed the therapeutic effect of Amlodipine in patients with NYHA Class III and IV heart failure and a left ventricular ejection fraction (LVEF) <30%. BNP, NT-proBNP, and NT-proANP levels were all correlated with 1-year mortality by univariate Cox proportional hazards analyses. With respect to multivariate Cox proportional hazards regression models containing variables deemed significant in univariate analyses, NT-proANP alone was identified as an independent predictor of 1-year mortality when log-transformed continuous covariates were utilized in the analysis. When the analysis was repeated using dichotomous covariates, NT-proANP remained the most significant predictor of 1-year mortality, followed by NT-proBNP, NYHA classification and BNP. We conclude that all three natriuretic peptides are significant predictors of short-term mortality in subjects with chronic congestive heart failure (CHF) of a presumed nonischaemic origin. Larger prospective studies are required to validate the clinical utility of NT-proANP as a discriminating marker of short-term survival, and to validate proposed cutoffs of approximately 2300 pmol/l for NT-proANP, 1500 pg/ml for NT-proBNP, and 50 pmol/l for BNP as prognostic indicators of adverse short-term outcome.
Key Words: Heart failure • Natriuretic peptides • Survival
Received September 4, 2003; Revised May 12, 2004; Accepted June 27, 2004
1 Present Address: Faculty of Medicine, University of Montreal, 2900 Edouard Montpetit Boulevard, Montreal, Quebec, Canada H3C 3J4.
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