Nicholas Wettersten1,2, Yu Horiuchi1,2, Dirk J van Veldhuisen3, Christian Mueller4, Gerasimos Filippatos5, Richard Nowak6, Christopher Hogan7, Michael C Kontos8, Chad M Cannon9, Gerhard A Müeller10, Robert Birkhahn11, Pam Taub1, Gary M Vilke12, Olga Barnett13, Kenneth McDonald14,15, Niall Mahon14, Julio Nuñez16, Carlo Briguori17, Claudio Passino18, Patrick T Murray14, Alan Maisel1. 1. Division of Cardiovascular Medicine, University of California, San Diego, CA, USA. 2. Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, CA, USA. 3. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 4. Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. 5. Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece. 6. Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan, USA. 7. Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA. 8. Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA. 9. Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA. 10. Department of Nephrology and Rheumatology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany. 11. Department of Emergency Medicine, New York Methodist, Brooklyn, NY, USA. 12. Department of Emergency Medicine, University of California, San Diego, CA, USA. 13. Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine. 14. Department of Cardiology, Mater Misericordiae University Hospital, University College, Dublin, Ireland. 15. Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland. 16. Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, University of Valencia, Valencia, Spain & CIBER in Cardiovascular Diseases, Madrid, Spain. 17. Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy. 18. Department of Cardiology and Cardiovascular Medicine, 'Gabriele Monasterio' Foundation, Pisa, Italy.
Abstract
AIMS: In acute heart failure (AHF), relationships between changes in B-type natriuretic peptide (BNP) and worsening renal function (WRF) and its prognostic implications have not been fully determined. We investigated the relationship between WRF and a decrease in BNP with in-hospital and 1-year mortality in AHF. METHODS AND RESULTS: The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicentre study of AHF patients. Severe WRF (sWRF) was a sustained increase of ≥44.2 μmol/L (0.5 mg/dL) or ≥50% in creatinine, non-severe WRF (nsWRF) was a non-sustained increase of ≥26.5 μmol/L (0.3 mg/dL) or ≥50% in creatinine, and WRF with clinical deterioration was nsWRF with renal replacement therapy, inotrope use, or mechanical ventilation. Decreased BNP was defined as a ≥30% reduction in the last measured BNP compared to admission BNP. Among 814 patients, the incidence of WRF was not different between patients with or without decreased BNP (nsWRF: 33% vs. 31%, P = 0.549; sWRF: 11% vs. 9%, P = 0.551; WRF with clinical deterioration: 8% vs. 10%, P = 0.425). Decreased BNP was associated with better in-hospital and 1-year mortality regardless of WRF, while WRF was associated with worse outcomes only in patients without decreased BNP. In multivariate Cox regression analysis, decreased BNP, sWRF, and WRF with clinical deterioration were significantly associated with 1-year mortality. CONCLUSIONS: Decreased BNP was associated with better in-hospital and long-term outcomes. WRF was only associated with adverse outcomes in patients without decreased BNP.
AIMS: In acute heart failure (AHF), relationships between changes in B-type natriuretic peptide (BNP) and worsening renal function (WRF) and its prognostic implications have not been fully determined. We investigated the relationship between WRF and a decrease in BNP with in-hospital and 1-year mortality in AHF. METHODS AND RESULTS: The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicentre study of AHFpatients. Severe WRF (sWRF) was a sustained increase of ≥44.2 μmol/L (0.5 mg/dL) or ≥50% in creatinine, non-severe WRF (nsWRF) was a non-sustained increase of ≥26.5 μmol/L (0.3 mg/dL) or ≥50% in creatinine, and WRF with clinical deterioration was nsWRF with renal replacement therapy, inotrope use, or mechanical ventilation. Decreased BNP was defined as a ≥30% reduction in the last measured BNP compared to admission BNP. Among 814 patients, the incidence of WRF was not different between patients with or without decreased BNP (nsWRF: 33% vs. 31%, P = 0.549; sWRF: 11% vs. 9%, P = 0.551; WRF with clinical deterioration: 8% vs. 10%, P = 0.425). Decreased BNP was associated with better in-hospital and 1-year mortality regardless of WRF, while WRF was associated with worse outcomes only in patients without decreased BNP. In multivariate Cox regression analysis, decreased BNP, sWRF, and WRF with clinical deterioration were significantly associated with 1-year mortality. CONCLUSIONS: Decreased BNP was associated with better in-hospital and long-term outcomes. WRF was only associated with adverse outcomes in patients without decreased BNP.
Authors: Wouter C Meijers; Antoni Bayes-Genis; Alexandre Mebazaa; Johann Bauersachs; John G F Cleland; Andrew J S Coats; James L Januzzi; Alan S Maisel; Kenneth McDonald; Thomas Mueller; A Mark Richards; Petar Seferovic; Christian Mueller; Rudolf A de Boer Journal: Eur J Heart Fail Date: 2021-10-10 Impact factor: 17.349