BACKGROUND: Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients. METHODS AND RESULTS: Outpatients referred for echocardiogram (n=829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62-2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11-3.28). CONCLUSIONS: Individuals without any history of HF but with BNP >or=100pg/mL are at equal or higher risk than those with a HF history whose BNP is <100pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events. Copyright 2010 Elsevier Inc. All rights reserved.
BACKGROUND:Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients. METHODS AND RESULTS: Outpatients referred for echocardiogram (n=829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62-2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11-3.28). CONCLUSIONS: Individuals without any history of HF but with BNP >or=100pg/mL are at equal or higher risk than those with a HF history whose BNP is <100pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events. Copyright 2010 Elsevier Inc. All rights reserved.
Authors: Lori B Daniels; Gail A Laughlin; Donna Kritz-Silverstein; Paul Clopton; Wei-Chung Chen; Alan S Maisel; Elizabeth Barrett-Connor Journal: Am J Med Date: 2011-07 Impact factor: 4.965