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N-terminal pro-B-type natriuretic peptide and long-term mortality in non-ischaemic cardiomyopathy

N-Terminales Pro-B-Typ Natriuretisches Peptid und Langzeit-Sterblichkeit bei Patienten mit nicht-ischämischer Kardiomyopathie

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Zusammenfassung

ZIEL: N-Terminales Pro-B-Typ Natriuretisches Peptid (NT-proBNP) ist ein starker Prädiktor für Sterblichkeit bei Patienten mit akuter und chronischer Herzinsuffizienz bedingt durch eine ischämische Herzerkrankung. Hingegen ist die prognostische Aussagekraft bei Patienten mit nicht-ischämischer Herzerkrankung weit weniger etabliert. Wir haben daher den Zusammenhang von NT-proBNP Serumspiegeln und Langzeit-Sterblichkeit von Patienten mit nicht-ischämischer Kardiomyopathie untersucht. METHODEN: Bei 156 Patienten, die sich mit einer invasiv gesicherten nicht-ischämischen Herzinsuffizienz in unserer Klinik vorstellten, wurden die NT-proBNP Serumspiegel bestimmt. Die Gesamtsterblichkeitsrate wurde im Rahmen eines mittleren Beobachtungszeitraums von 8.9 Jahren erhoben. ERGEBNISSE: Unter Verwendung eines proportionalen Cox Risiko Models konnte in multivariaten Analysen NT-proBNP und der linksventrikuläre diastolische Durchmesser als Prädiktoren für kardial bedingte Sterblichkeit mit einer geschätzten Hazard Ratio von 2.76 (95 % KI: 1.53, 4.98) und 1.06 (95 % KI: 1.02, 1.10) beobachtet werden. SCHLUSSFOLGERUNG: In dieser bisher längsten Nachbeobachtung eignete sich NT-proBNP auch bei Patienten mit nicht-ischämischer Kardiomyopathie als Risikoprädiktor für Sterblichkeit und war einer Beurteilung nach der New York Heart Association Klasse und der linksventrikulären Ejektionsfraktion überlegen.

Summary

AIM: The inactive N-terminal fragment of B-type natriuretic peptide is a strong predictor of mortality among patients with acute and chronic heart failure secondary to ischaemic heart disease. Its prognostic utility in patients with non-ischaemic heart disease is not well established. We therefore assessed the relationship of N-terminal proBNP levels and long-term mortality in patients with non-ischaemic cardiomyopathy. METHODS: N-terminal proBNP was measured in serum samples of 156 patients who presented to a single academic centre with worsening heart failure secondary to non-ischaemic cardiomyopathy. The rate of death from all causes was determined after a mean follow-up of 8.9 years. RESULTS: Multivariate analyses, using Cox proportional hazards models, established NT-proBNP and left ventricular diastolic diameter as predictors for cardiac mortality with estimated hazard ratios of 2.76 (95% confidence interval: 1.53, 4.98) and 1.06 (95% confidence interval: 1.02, 1.10), respectively. CONCLUSION: This to date longest-term analysis of N-terminal proBNP and mortality in patients with proven non-ischaemic cardiomyopathy confirms this cardiac-specific biomarker as powerful, independent risk predictor. It is a superior prognostic determinant to New York Heart Association functional class and left ventricular ejection fraction.

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Authors and Affiliations

  1. Department of Internal Medicine – Cardiology, Charité-Universitätsmedizin Campus Virchow, Berlin, Germany

    Florian Krackhardt, Hans-Dirk Düngen, Tobias Daniel Trippel, Simone Inkrot, Verena Tscholl, Kathrin Kehrt & Wilhelm Haverkamp

  2. Institut für Medizinische Statistik, Informatik und Dokumentation, Universitätsklinikum Jena, Jena, Germany

    Peter Schlattmann

Authors
  1. Florian Krackhardt
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  2. Hans-Dirk Düngen
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  3. Tobias Daniel Trippel
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  4. Simone Inkrot
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  5. Verena Tscholl
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  6. Peter Schlattmann
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  7. Kathrin Kehrt
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  8. Wilhelm Haverkamp
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Correspondence to Hans-Dirk Düngen.

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Florian Krackhardt and Hans-Dirk Düngen authors contributed equally.

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Krackhardt, F., Düngen, HD., Trippel, T. et al. N-terminal pro-B-type natriuretic peptide and long-term mortality in non-ischaemic cardiomyopathy. Wien Klin Wochenschr 123, 738–742 (2011). https://doi.org/10.1007/s00508-011-0092-y

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  • DOI: https://doi.org/10.1007/s00508-011-0092-y

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