Profiling B-type natriuretic peptide in a stable heart failure population: a valuable adjunct to care
To examine the prognostic importance of absolute values and change in values of BNP in patients with stable heart failure (HF).
Five-hundred and fifty-nine patients attending a disease management programme were categorized into tertiles of BNP (group 1; ≤95 pg/ml, group 2; 96–249 pg/ml and group 3; ≥250 pg/ml). A change in BNP between two stable visits was recorded. Patients were followed up for 1 year for death and a composite morbidity measure of HF hospitalization, all-cause hospitalization, unscheduled visits for clinical deterioration(UC) of HF using survival analysis.
The risk of the combined morbidity outcome increased with increasing tertiles of BNP (Log rank = 17.8 (2), p < 0.001). Furthermore, a 50 and 25% increase in BNP predicted morbidity in stable HF patients with an initial BNP > 200 pg/ml (p = 0.02) and >450 pg/ml (p = 0.03), respectively.
In a stable community HF population, an elevated BNP or an increase in BNP predicts an adverse prognosis thereby potentially identifying a population in need of closer clinical follow-up.
KeywordsB-type natriuretic peptide Heart failure Disease management programme
Conflicts of interest
KMCD and ML have received honoraria from Biosyn. There are no other conflicts of interest.
- 8.de Groote P, Dagorn J, Soudan B, Lamblin N, McFadden E, Bauters C (2004) B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure. J Am Coll Cardiol 43:1584–1589PubMedCrossRefGoogle Scholar
- 12.Castellanos LR, Bhalla V, Isakson S, et al (2008) B-type Natriuretic peptide and impedance cardiography at the time of routine echocardiography predict subsequent heart failure events. J Card Fail (article in press)Google Scholar
- 19.Nieminen MS, Böhm M, Cowie MR et al (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26:384–416Google Scholar
- 21.Hosmer D, Lemeshow S (1999) Applied survival analysis: regression modeling of time to event data. John Wiley & Sons, Inc, New YorkGoogle Scholar
- 22.Maeda K, Tsutamoto T, Wada A et al (2000) High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 36:1587–1593PubMedCrossRefGoogle Scholar
- 29.Christ M, Laule-Kilian K, Hochholzer W et al (2006) Gender-specific risk stratification with B-type natriuretic peptide levels in patients with acute dyspnea: insights from the B-type natriuretic peptide for acute shortness of breath evaluation study. J Am Coll Cardiol 48:1808–1812PubMedCrossRefGoogle Scholar