Susan Stienen1, Khibar Salah1, Cathelijne Dickhoff1, Valentina Carubelli2, Marco Metra3, Laura Magrini3, Salvatore Di Somma3, Jan P Tijssen1, Yigal M Pinto1, Wouter E Kok4. 1. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 2. Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 3. Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Sant' Andrea Hospital, Rome, Italy. 4. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: w.e.kok@amc.uva.nl.
Abstract
BACKGROUND: A >30% N-terminal pro-B-type natriuretic peptide (NT-proBNP) reduction at discharge in acute decompensated heart failure (ADHF) predicts a favorable prognosis. To study the feasibility of guiding ADHF treatment by measuring NT-proBNP well before discharge, we assessed at which moment during hospitalization patients attain a NT-proBNP reduction of >30% (target) and whether this target is still attained at discharge. METHODS: Twenty-five consecutive ADHF patients with NT-proBNP >1,700 ng/L were included (original cohort). NT-proBNP was measured daily until the target was attained, at clinical stability, and at discharge and was analyzed as percentages of patients on target. For comparison purposes, the same analysis was performed in individual patient data from 2 other ADHF cohorts (42 and 111 patients, respectively), in which NT-proBNP was measured from admission to day 3 and at discharge. RESULTS: In the original cohort of 25 patients (median age 70 years, 40% male), the cumulative percentage of patients attaining the target increased gradually during admission to 22 patients (88%) in a median of 3 days (interquartile range 2-5). In the comparison cohorts, a similar course was observed in patients attaining the target before discharge. Compared with levels measured at days 2 and 3, rebound NT-proBNP increases to levels off-target at discharge were seen in up to 33% of patients in the original and comparison cohorts. CONCLUSION: A target >30% NT-proBNP reduction is gradually attained before discharge, and rebound NT-proBNP increases to levels off-target occur in up to 33% of ADHF patients who initially attained target early during admission.
BACKGROUND: A >30% N-terminal pro-B-type natriuretic peptide (NT-proBNP) reduction at discharge in acute decompensated heart failure (ADHF) predicts a favorable prognosis. To study the feasibility of guiding ADHF treatment by measuring NT-proBNP well before discharge, we assessed at which moment during hospitalization patients attain a NT-proBNP reduction of >30% (target) and whether this target is still attained at discharge. METHODS: Twenty-five consecutive ADHF patients with NT-proBNP >1,700 ng/L were included (original cohort). NT-proBNP was measured daily until the target was attained, at clinical stability, and at discharge and was analyzed as percentages of patients on target. For comparison purposes, the same analysis was performed in individual patient data from 2 other ADHF cohorts (42 and 111 patients, respectively), in which NT-proBNP was measured from admission to day 3 and at discharge. RESULTS: In the original cohort of 25 patients (median age 70 years, 40% male), the cumulative percentage of patients attaining the target increased gradually during admission to 22 patients (88%) in a median of 3 days (interquartile range 2-5). In the comparison cohorts, a similar course was observed in patients attaining the target before discharge. Compared with levels measured at days 2 and 3, rebound NT-proBNP increases to levels off-target at discharge were seen in up to 33% of patients in the original and comparison cohorts. CONCLUSION: A target >30% NT-proBNP reduction is gradually attained before discharge, and rebound NT-proBNP increases to levels off-target occur in up to 33% of ADHF patients who initially attained target early during admission.
Authors: Frances M Russell; Robert R Ehrman; Robinson Ferre; Luna Gargani; Vicki Noble; Jordan Rupp; Sean P Collins; Benton Hunter; Kathleen A Lane; Phillip Levy; Xiaochun Li; Christopher O'Connor; Peter S Pang Journal: Heart Lung Date: 2018-11-15 Impact factor: 2.210
Authors: Simon de Denus; Grégoire Leclair; Marie-Pierre Dubé; Isabelle St-Jean; Yassamin Feroz Zada; Essaïd Oussaïd; Martin Jutras; Michael M Givertz; Robert J Mentz; W H Wilson Tang; João Pedro Ferreira; Jean Rouleau; Javed Butler; Andreas P Kalogeropoulos Journal: Eur J Heart Fail Date: 2020-04-01 Impact factor: 15.534