Nobuyuki Kagiyama1, Takeshi Kitai2, Akihiro Hayashida3, Tetsuo Yamaguchi4, Takahiro Okumura5, Keisuke Kida6, Atsushi Mizuno7, Shogo Oishi8, Yasutaka Inuzuka9, Eiichi Akiyama10, Satoshi Suzuki11, Masayoshi Yamamoto12, Akane Shimizu13, Yu Urakami13, Misako Toki14, Shingo Aritaka14, Kozue Matsumoto15, Noriko Nagano15, Keizo Yamamoto3, Yuya Matsue16. 1. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; Division of Cardiology, West Virginia University, Morgantown, West Virginia; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 2. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 3. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 4. Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan. 5. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 6. Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan. 7. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. 8. Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan. 9. Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan. 10. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 11. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan. 12. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 13. Departments of Pharmacy, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 14. Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 15. Departments of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 16. Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: yuya8950@gmail.com.
Abstract
BACKGROUND: Prognostication of patients discharged after acute heart failure (AHF) hospitalization remains challenging. Body weight (BW) reduction is often used as a surrogate marker of decongestion despite the paucity of evidence. We thought to test the hypothesis that B-type natriuretic peptide (BNP) reduction during hospitalization has independent prognostic value in AHF. METHODS AND RESULTS: We studied the prognostic predictability of percentage BNP reduction achieved during hospitalization in patients from the REALITY-AHF study. Percentage BNP reduction was defined as (BNP on admission - BNP at discharge) / BNP on admission × 100. The primary endpoint was 1-year all-cause death. In 1028 patients (age, 77 ± 13 years; 57% male; left ventricular ejection fraction, 47 ± 16%) with AHF, median BNP level at admission was 747 ng/L (interquartile range, 439-1367 ng/L) and median percentage BNP reduction was 62.5% (interquartile range, 36.5-78.5%). The smallest percentage BNP reduction quartile had more than 2-fold higher risk of all-cause death than the greatest quartile (23.0% vs 9.7%, P< .001). After adjusting for covariates including BNP at discharge, the percentage BNP reduction was significantly associated with all-cause death (hazard ratio 0.96, 95% confidence interval 0.93-0.99, P= .032), whereas percentage BW reduction was not. Percentage BNP reduction was more predictive in patients with heart failure with reduced ejection fraction than in those with preserved ejection fraction. CONCLUSIONS: The prognostic value of percentage BNP reduction during hospitalization was superior to that of percentage BW reduction and was independent of other risk markers, including BNP at discharge.
BACKGROUND: Prognostication of patients discharged after acute heart failure (AHF) hospitalization remains challenging. Body weight (BW) reduction is often used as a surrogate marker of decongestion despite the paucity of evidence. We thought to test the hypothesis that B-type natriuretic peptide (BNP) reduction during hospitalization has independent prognostic value in AHF. METHODS AND RESULTS: We studied the prognostic predictability of percentage BNP reduction achieved during hospitalization in patients from the REALITY-AHF study. Percentage BNP reduction was defined as (BNP on admission - BNP at discharge) / BNP on admission × 100. The primary endpoint was 1-year all-cause death. In 1028 patients (age, 77 ± 13 years; 57% male; left ventricular ejection fraction, 47 ± 16%) with AHF, median BNP level at admission was 747 ng/L (interquartile range, 439-1367 ng/L) and median percentage BNP reduction was 62.5% (interquartile range, 36.5-78.5%). The smallest percentage BNP reduction quartile had more than 2-fold higher risk of all-cause death than the greatest quartile (23.0% vs 9.7%, P< .001). After adjusting for covariates including BNP at discharge, the percentage BNP reduction was significantly associated with all-cause death (hazard ratio 0.96, 95% confidence interval 0.93-0.99, P= .032), whereas percentage BW reduction was not. Percentage BNP reduction was more predictive in patients with heart failure with reduced ejection fraction than in those with preserved ejection fraction. CONCLUSIONS: The prognostic value of percentage BNP reduction during hospitalization was superior to that of percentage BW reduction and was independent of other risk markers, including BNP at discharge.
Authors: Otto Mayer; Jan Bruthans; Simona Bilkova; Jitka Seidlerova; Josef Jirak; Jan Filipovsky Journal: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Date: 2022-04-20 Impact factor: 1.648
Authors: Nadia Aspromonte; Luigi Cappannoli; Pietro Scicchitano; Francesco Massari; Ivan Pantano; Massimo Massetti; Filippo Crea; Roberto Valle Journal: J Clin Med Date: 2021-05-14 Impact factor: 4.241