BACKGROUND: Concentrations of B-type natriuretic peptides (BNPs), including N-terminal pro-B-type natriuretic peptide (NT-proBNP), can be used to estimate prognosis in chronic heart failure. Large biologic variability, however, limits the usefulness of serial measurements in individual patients. As a result, the magnitude of change in peptide concentrations that is clinically meaningful remains to be established. METHODS: We studied 172 New York Heart Association class III-IV outpatients. Primary endpoints were death/transplantation or heart failure hospitalization. The magnitude of peptide changes was categorized as no change (<20% increase or decrease from enrollment), > or =20% to < or =80% increase or decrease; and >80% increase or decrease. Changes were also assessed using cutpoints (500 ng/L for BNP and 1000 ng/L for NT-proBNP). RESULTS: Fifty-two patients died or received transplants during the course of the study. Risk reduction for heart failure hospitalization was demonstrated only for BNP decreases of >80% from enrollment [hazard ratio (HR) 0.318, P = 0.0315]. BNP increases from less than to more than the prespecified cutpoint of 500 ng/L were associated with increased mortality risk (HR 2.101, P = 0.0069), whereas decreases from more than to less than the cutpoint did not reduce risk. NT-proBNP decreases from more than to less than the cutpoint of 1000 ng/L were associated with reduced risk of death/transplantation (HR 0.119, P = 0.0354). CONCLUSIONS: BNP increases from less than to more than the cutpoint were associated with increased risk of events, whereas further increases did not add to risk. In contrast, only substantial natriuretic peptide decreases (>80%) reduced risk. These data suggest that only robust decreases in natriuretic peptide concentrations should be targeted to reduce mortality and heart failure-related hospitalizations.
BACKGROUND: Concentrations of B-type natriuretic peptides (BNPs), including N-terminal pro-B-type natriuretic peptide (NT-proBNP), can be used to estimate prognosis in chronic heart failure. Large biologic variability, however, limits the usefulness of serial measurements in individual patients. As a result, the magnitude of change in peptide concentrations that is clinically meaningful remains to be established. METHODS: We studied 172 New York Heart Association class III-IV outpatients. Primary endpoints were death/transplantation or heart failure hospitalization. The magnitude of peptide changes was categorized as no change (<20% increase or decrease from enrollment), > or =20% to < or =80% increase or decrease; and >80% increase or decrease. Changes were also assessed using cutpoints (500 ng/L for BNP and 1000 ng/L for NT-proBNP). RESULTS: Fifty-two patients died or received transplants during the course of the study. Risk reduction for heart failure hospitalization was demonstrated only for BNP decreases of >80% from enrollment [hazard ratio (HR) 0.318, P = 0.0315]. BNP increases from less than to more than the prespecified cutpoint of 500 ng/L were associated with increased mortality risk (HR 2.101, P = 0.0069), whereas decreases from more than to less than the cutpoint did not reduce risk. NT-proBNP decreases from more than to less than the cutpoint of 1000 ng/L were associated with reduced risk of death/transplantation (HR 0.119, P = 0.0354). CONCLUSIONS:BNP increases from less than to more than the cutpoint were associated with increased risk of events, whereas further increases did not add to risk. In contrast, only substantial natriuretic peptide decreases (>80%) reduced risk. These data suggest that only robust decreases in natriuretic peptide concentrations should be targeted to reduce mortality and heart failure-related hospitalizations.
Authors: Kirkwood F Adams; G Michael Felker; Ghassan Fraij; J Herbert Patterson; Christopher M O'Connor Journal: Heart Fail Rev Date: 2010-07 Impact factor: 4.214
Authors: Wayne L Miller; Karen A Hartman; David O Hodge; Stacy Hartman; Joachim Struck; Nils G Morgenthaler; Andreas Bergmann; Allan S Jaffe Journal: J Cardiovasc Transl Res Date: 2009-08-14 Impact factor: 4.132
Authors: Wayne L Miller; Karen A Hartman; Diane E Grill; Joachim Struck; Andreas Bergmann; Allan S Jaffe Journal: Heart Date: 2011-12-22 Impact factor: 5.994
Authors: Nisha Bansal; Leila R Zelnick; Elsayed Z Soliman; Amanda Anderson; Robert Christenson; Christopher DeFilippi; Rajat Deo; Harold I Feldman; Jiang He; Bonnie Ky; John Kusek; James Lash; Stephen Seliger; Tariq Shafi; Myles Wolf; Alan S Go; Michael G Shlipak Journal: Am J Kidney Dis Date: 2020-12-09 Impact factor: 11.072
Authors: Julien Magne; Michelle Dubois; Jean Champagne; Jean G Dumesnil; Philippe Pibarot; François Philippon; Gilles O'Hara; Mario Sénéchal Journal: Cardiovasc Ultrasound Date: 2009-08-20 Impact factor: 2.062