BACKGROUND: N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied. METHODS AND RESULTS: This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond (P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors (P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03). CONCLUSION: NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.
BACKGROUND: N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied. METHODS AND RESULTS: This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond (P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors (P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03). CONCLUSION: NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.
Authors: Pasqualina L Santaguida; Andrew C Don-Wauchope; Mark Oremus; Robert McKelvie; Usman Ali; Stephen A Hill; Cynthia Balion; Ronald A Booth; Judy A Brown; Amy Bustamam; Nazmul Sohel; Parminder Raina Journal: Heart Fail Rev Date: 2014-08 Impact factor: 4.214
Authors: Shivanand Shankar Medar; Daphne T Hsu; H Michael Ushay; Jacqueline M Lamour; Hillel W Cohen; James S Killinger Journal: Pediatr Crit Care Med Date: 2015-07 Impact factor: 3.624
Authors: Robb D Kociol; John R Horton; Gregg C Fonarow; Eric M Reyes; Linda K Shaw; Christopher M O'Connor; G Michael Felker; Adrian F Hernandez Journal: Circ Heart Fail Date: 2011-07-08 Impact factor: 8.790
Authors: Robb D Kociol; Steven E McNulty; Adrian F Hernandez; Kerry L Lee; Margaret M Redfield; Russell P Tracy; Eugene Braunwald; Christopher M O'Connor; G Michael Felker Journal: Circ Heart Fail Date: 2012-12-18 Impact factor: 8.790
Authors: James B Wetmore; Rajyalakshmi Gadi; John H Lee; James H O'Keefe; Paul S Chan; Fengming Tang; John A Spertus Journal: BMC Res Notes Date: 2011-12-15