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Is there an additional benefit of serial NT-proBNP measurements in patients with stable chronic heart failure receiving individually optimized therapy?

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Abstract

Background

The role of serial NT-proBNP measurements in patients suffering from chronic systolic heart failure (CHF) who already receive individually optimized pharmacotherapy is still unresolved.

Methods

NT-proBNP was assessed at baseline and at 6 months follow-up in 504 stable CHF patients treated with individually optimized pharmacotherapy. After assessment of clinical stability at 6 months, patients were followed up for at least 1 year. The combined primary endpoint was defined as death, hospitalization due to cardiac reasons or heart transplantation in 1-year follow-up. We stratified our patients according to two principles: first, a percent change of value (CV) between the first and second measurement of NT-proBNP and secondly, the transformed logarithm of NT-proBNP measured at 6 months.

Results

During the follow-up period of 1 year, 50 patients (9.9%) reached the combined primary endpoint. Stratification according to percentage CV was less accurate in predicting endpoint-free survival compared to a classification in categories of lnNT-proBNP measured at 6 months (ROC AUC = 0.615; 95% CI 0.525–0.70 vs. ROC AUC = 0.790; 95% CI 0.721–0.856, respectively). When entered into proportional hazard regression analysis, lnNT-proBNP measured at 6 months remained an independent predictor of the combined primary endpoint with an associated HR of 2.53 (95% CI 1.385–4.280).

Conclusion

To date, this is the largest analysis of serial NT-proBNP measurements in patients with CHF receiving individually optimized medical therapy. These data suggest that a single NT-proBNP measurement after 6 months in stable clinical conditions may have higher predictive value than stratification of change in serial measurements.

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Abbreviations

ACE-I:

Angiotensin-converting Enzyme Inhibitor

ARB:

Angiotensin receptor blocker

AUC:

Area under the receiver operating characteristic curve

BBL:

Beta-blocker

BNP:

Brain natriuretic peptide

CHF:

Chronic heart failure

CI:

Confidence interval

CV:

Change value

DCM:

Dilated cardiomyopathy

ECG:

Electrocardiography

EF:

Left ventricular ejection fraction

HF:

Heart failure

HR:

Hazard ratio

ICM:

Ischemic cardiomyopathy

LBBB:

Left bundle branch block

LVEDD:

End diastolic left ventricular internal diameter

lnNT-proBNP:

Transformed logarithm of NT-proBNP

NT-proBNP:

N-terminal pro-peptide of brain natriuretic peptide

NYHA:

New York Heart Association

ROC:

Receiver operating characteristics analysis

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Acknowledgments

This study was supported by a grant from the Carl-Baresel-Foundation. J. F. was supported by the Rahel Goitein-Straus Research Program of the Medical Faculty Heidelberg.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Jennifer Franke, Lutz Frankenstein, Dieter Schellberg, Amer Bajrovic, Jan Sebastian Wolter, Philipp Ehlermann, Andreas O. Doesch, Manfred Nelles, Hugo A. Katus & Christian Zugck

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  1. Jennifer Franke
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Correspondence to Jennifer Franke.

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Franke, J., Frankenstein, L., Schellberg, D. et al. Is there an additional benefit of serial NT-proBNP measurements in patients with stable chronic heart failure receiving individually optimized therapy?. Clin Res Cardiol 100, 1059–1067 (2011). https://doi.org/10.1007/s00392-011-0340-1

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