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Prognostic value of N-Terminal Pro-B-Type Natriuretic Peptide in Takotsubo syndrome

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Abstract

Background

Takotsubo syndrome (TTS), a form of acute transient heart failure, has been associated with severe complications and considerable mortality rates. N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) might serve as a marker to identify high-risk patients but has not yet been investigated regarding prognostic implications in TTS. Aim of this study was to determine the short- and long-term prognostic utility of NT-proBNP in patients with TTS.

Methods

The predictive value of admission NT-proBNP was assessed in an international, multicenter study including 177 consecutive TTS patients. Predefined endpoints were 30-day major adverse cardiac events (MACE) consisting of all-cause death, cardiogenic shock, and pulmonary edema as well as long-term mortality in median 2.3 years after the acute event.

Results

Stratification according to median admission NT-proBNP (4511 pg/ml) resulted in significantly higher 30-day MACE [22.5 versus 9.1%; odds ratio (OR) 2.90, 95% confidence interval (CI) 1.20–6.99 p = 0.015] and long-term mortality rates [16.3 versus 9.4%; hazard ratio (HR) 2.72, 95% CI 1.13–6.56 p = 0.021] in patients > median. The best admission NT-proBNP cutoffs to predict 30-day MACE and long-term mortality were determined at 5560 and 8178 pg/ml respectively, with subsequent improved risk stratification for short-term MACE (OR 3.61, 95% CI 1.49–8.72; p = 0.003) and long-term mortality (HR 4.40; 95% CI 1.85–10.44, p < 0.001). Multivariate regression analysis identified admission NT-proBNP as an independent predictor of 30-day MACE (p < 0.001) and long-term mortality (p = 0.012).

Conclusions

Admission NT-proBNP is an independent predictor for short- and long-term adverse events in TTS patients and, therefore, a useful marker for risk stratification immediately at presentation.

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Author notes

  1. Thomas Stiermaier and Francesco Santoro have contributed equally and should be considered as first authors.

Authors and Affiliations

  1. University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Thomas Stiermaier, Tobias Graf, Christian Möller & Ingo Eitel

  2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany

    Thomas Stiermaier, Tobias Graf, Christian Möller & Ingo Eitel

  3. Department of Medical and Surgical Science, University of Foggia, Foggia, Italy

    Francesco Santoro, Francesca Guastafierro, Nicola Tarantino, Matteo Di Biase & Natale D. Brunetti

  4. Department of Cardiology, San Paolo Hospital, Bari, Italy

    Luisa De Gennaro & Pasquale Caldarola

  5. Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany

    Holger Thiele

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  1. Thomas Stiermaier
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Correspondence to Ingo Eitel.

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Christian Möller and Ingo Eitel should be considered equally as senior authors.

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Stiermaier, T., Santoro, F., Graf, T. et al. Prognostic value of N-Terminal Pro-B-Type Natriuretic Peptide in Takotsubo syndrome. Clin Res Cardiol 107, 597–606 (2018). https://doi.org/10.1007/s00392-018-1227-1

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