Circulation. 2004;110:2168-2174
Published online before print September 27, 2004, doi: 10.1161/01.CIR.0000144310.04433.BE
Published online before print September 27, 2004, doi: 10.1161/01.CIR.0000144310.04433.BE
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:2168-2174.)
© 2004 American Heart Association, Inc.
Heart Failure |
N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients
From the Departamento de Medicina Interna, Serviço de Medicina B–Hospital S. João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
Correspondence to Paulo Bettencourt, Serviço de Medicina B, Hospital S. João–Piso 4, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. E-mail pbettfer{at}esoterica.pt
Received October 27, 2003; de novo received March 9, 2004; revision received May 12, 2004; accepted June 2, 2004.
Background— Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal–pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients.
Methods and Results— We included 182 patients consecutively admitted to hospital because of decompensated HF. Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL (P<0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (n=82), (2) no significant modifications on NT-proBNP levels (n=49), and (3) increasing NT-proBNP levels by at least 30% (n=25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rate, signs of volume overload, no use of ACE inhibitors, higher NYHA class at discharge, admission and discharge NT-proBNP, and the change in NT-proBNP levels. The variation in NT-proBNP was the strongest predictor of an adverse outcome. Independent variables associated with an increased risk of readmission or death were signs of volume overload and the change in NT-proBNP levels.
Conclusions— Variations in NT-proBNP levels are related to hospital readmission and death within 6 months. NT-proBNP levels are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients. Whether therapeutic strategies aimed to lower NT-proBNP levels modify prognosis warrants future investigation.
Key Words: heart failure • mortality • natriuretic peptides • prognosis
This article has been cited by other articles:
 |
|
 |
|
  A. Cohen-Solal, D. Logeart, B. Huang, D. Cai, M. S. Nieminen, and A. Mebazaa Lowered B-Type Natriuretic Peptide in Response to Levosimendan or Dobutamine Treatment Is Associated With Improved Survival in Patients With Severe Acutely Decompensated Heart Failure J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2343 - 2348. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kubanek, K. M. Goode, V. Lanska, A. L. Clark, and J. G.F. Cleland The prognostic value of repeated measurement of N-terminal pro-B-type natriuretic peptide in patients with chronic heart failure due to left ventricular systolic dysfunction Eur J Heart Fail, April 1, 2009; 11(4): 367 - 377. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gustafsson, M. Schou, L. Videbaek, N. Dridi, H. Ryde, J. Handberg, P. R. Hildebrandt, and on behalf of the Danish Heart Failure Clinics Netw Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics Eur J Heart Fail, April 1, 2009; 11(4): 413 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. L. Miller, K. A. Hartman, D. E. Grill, J. C. Burnett Jr, and A. S. Jaffe Only Large Reductions in Concentrations of Natriuretic Peptides (BNP and NT-proBNP) Are Associated with Improved Outcome in Ambulatory Patients with Chronic Heart Failure Clin. Chem., January 1, 2009; 55(1): 78 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Nieminen, J. G.F. Cleland, J. Eha, Y. Belenkov, M. Kivikko, P. Poder, and T. Sarapohja Oral levosimendan in patients with severe chronic heart failure--The PERSIST study Eur J Heart Fail, December 1, 2008; 10(12): 1246 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Ross, G. K. Mulvey, B. Stauffer, V. Patlolla, S. M. Bernheim, P. S. Keenan, and H. M. Krumholz Statistical Models and Patient Predictors of Readmission for Heart Failure: A Systematic Review Arch Intern Med, July 14, 2008; 168(13): 1371 - 1386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Waldo, J. Beede, S. Isakson, S. Villard-Saussine, J. Fareh, P. Clopton, R. L. Fitzgerald, and A. S. Maisel Pro-B-Type Natriuretic Peptide Levels in Acute Decompensated Heart Failure J. Am. Coll. Cardiol., May 13, 2008; 51(19): 1874 - 1882. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W Yip B-type natriuretic peptide: a treatment, not a diagnostic marker Heart, May 1, 2008; 94(5): 542 - 544. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Pascual-Figal, M. Domingo, T. Casas, I. Gich, J. Ordonez-Llanos, P. Martinez, J. Cinca, M. Valdes, J. L. Januzzi, and A. Bayes-Genis Usefulness of clinical and NT-proBNP monitoring for prognostic guidance in destabilized heart failure outpatients Eur. Heart J., April 2, 2008; 29(8): 1011 - 1018. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Moertl, A. Hammer, M. Huelsmann, R. Pacher, and R. Berger Prognostic value of sequential measurements of amino-terminal prohormone of B-type natriuretic peptide in ambulatory heart failure patients Eur J Heart Fail, April 1, 2008; 10(4): 404 - 411. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Gardiwal, H. Yu, H. Oswald, U. Luesebrink, A. Ludwig, A. M. Pichlmaier, H. Drexler, and G. Klein Right ventricular pacing is an independent predictor for ventricular tachycardia/ventricular fibrillation occurrence and heart failure events in patients with an implantable cardioverter-defibrillator Europace, March 1, 2008; 10(3): 358 - 363. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Pfister, H. Diedrichs, A. Schiedermair, S. Rosenkranz, M. Hellmich, E. Erdmann, and C. A. Schneider Prognostic impact of NT-proBNP and renal function in comparison to contemporary multi-marker risk scores in heart failure patients Eur J Heart Fail, March 1, 2008; 10(3): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kumar, A. Dispenzieri, M. Q. Lacy, S. R. Hayman, N. Leung, S. R. Zeldenrust, F. K. Buadi, R. A. Kyle, S. V. Rajkumar, and M. A. Gertz Serum Uric Acid: Novel Prognostic Factor in Primary Systemic Amyloidosis Mayo Clin. Proc., March 1, 2008; 83(3): 297 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Latini, S. Masson, I. S. Anand, E. Missov, M. Carlson, T. Vago, L. Angelici, S. Barlera, G. Parrinello, A. P. Maggioni, et al. Prognostic Value of Very Low Plasma Concentrations of Troponin T in Patients With Stable Chronic Heart Failure Circulation, September 11, 2007; 116(11): 1242 - 1249. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A M. Richards Variability of NT-proBNP levels in heart failure: implications for clinical application Heart, August 1, 2007; 93(8): 899 - 900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Lassus, V.-P. Harjola, R. Sund, K. Siirila-Waris, J. Melin, K. Peuhkurinen, K. Pulkki, M. S. Nieminen, and for the FINN-AKVA Study group Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNP Eur. Heart J., August 1, 2007; 28(15): 1841 - 1847. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Metra, S. Nodari, G. Parrinello, C. Specchia, L. Brentana, P. Rocca, F. Fracassi, T. Bordonali, P. Milani, R. Danesi, et al. The role of plasma biomarkers in acute heart failure. Serial changes and independent prognostic value of NT-proBNP and cardiac troponin-T Eur J Heart Fail, August 1, 2007; 9(8): 776 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Olsson, K. Swedberg, J. G.F. Cleland, P. A. Spark, M. Komajda, M. Metra, C. Torp-Pedersen, W. J. Remme, A. Scherhag, P. Poole-Wilson, et al. Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a {beta}-blocker: Results from the Carvedilol Or Metoprolol European Trial (COMET) trial Eur J Heart Fail, August 1, 2007; 9(8): 795 - 801. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. L. Miller, K. A. Hartman, M. F. Burritt, D. E. Grill, R. J. Rodeheffer, J. C. Burnett Jr, and A. S. Jaffe Serial Biomarker Measurements in Ambulatory Patients With Chronic Heart Failure: The Importance of Change Over Time Circulation, July 17, 2007; 116(3): 249 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Emdin, C. Passino, C. Prontera, M. Fontana, R. Poletti, A. Gabutti, C. Mammini, A. Giannoni, L. Zyw, G. Zucchelli, et al. Comparison of Brain Natriuretic Peptide (BNP) and Amino-Terminal ProBNP for Early Diagnosis of Heart Failure Clin. Chem., July 1, 2007; 53(7): 1289 - 1297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Luthje, D. Vollmann, T. Drescher, P. Schott, D. Zenker, G. Hasenfuss, and C. Unterberg Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT-proBNP Eur J Heart Fail, June 1, 2007; 9(6-7): 716 - 722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. C. Fonarow, W. F. Peacock, C. O. Phillips, M. M. Givertz, M. Lopatin, and for the ADHERE Scientific Advisory Committee and I Admission B-Type Natriuretic Peptide Levels and In-Hospital Mortality in Acute Decompensated Heart Failure J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1943 - 1950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. M. Corteville, K. Bibbins-Domingo, A. H. B. Wu, S. Ali, N. B. Schiller, and M. A. Whooley N-Terminal Pro-B-Type Natriuretic Peptide as a Diagnostic Test for Ventricular Dysfunction in Patients With Coronary Disease: Data From the Heart and Soul Study Arch Intern Med, March 12, 2007; 167(5): 483 - 489. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Sakhuja, S. Green, E. M. Oestreicher, P. M. Sluss, E. Lee-Lewandrowski, K. B. Lewandrowski, and J. L. Januzzi Jr. Amino-Terminal Pro-Brain Natriuretic Peptide, Brain Natriuretic Peptide, and Troponin T for Prediction of Mortality in Acute Heart Failure Clin. Chem., March 1, 2007; 53(3): 412 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Sherwood, J. A. Blumenthal, R. Trivedi, K. S. Johnson, C. M. O'Connor, K. F. Adams Jr, C. S. Dupree, R. A. Waugh, D. R. Bensimhon, L. Gaulden, et al. Relationship of Depression to Death or Hospitalization in Patients With Heart Failure Arch Intern Med, February 26, 2007; 167(4): 367 - 373. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R.J. van Kimmenade, J. L. Januzzi Jr, A. L. Baggish, J. G. Lainchbury, A. Bayes-Genis, A. M. Richards, and Y. M. Pinto Amino-Terminal Pro-Brain Natriuretic Peptide, Renal Function, and Outcomes in Acute Heart Failure: Redefining the Cardiorenal Interaction? J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1621 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. V. Mikkelsen, J. E. Moller, P. Bie, H. Ryde, L. Videbaek, and T. Haghfelt Tei index and neurohormonal activation in patients with incident heart failure: Serial changes and prognostic value Eur J Heart Fail, October 1, 2006; 8(6): 599 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R. van Kimmenade, J. L. Januzzi Jr, P. T. Ellinor, U. C. Sharma, J. A. Bakker, A. F. Low, A. Martinez, H. J. Crijns, C. A. MacRae, P. P. Menheere, et al. Utility of Amino-Terminal Pro-Brain Natriuretic Peptide, Galectin-3, and Apelin for the Evaluation of Patients With Acute Heart Failure J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1217 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Klein, C. Lissel, A.-C. Fuchs, A. Gardiwal, H. Oswald, M. deSousa, A. M. Pichlmaier, R. Lichtinghagen, H. Geerlings, P. Lippolt, et al. Predictors of VT/VF-occurrence in ICD patients: results from the PROFIT-Study. Europace, August 1, 2006; 8(8): 618 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Jaffe, L. Babuin, and F. S. Apple Biomarkers in Acute Cardiac Disease: The Present and the Future J. Am. Coll. Cardiol., July 4, 2006; 48(1): 1 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kogler, P. Schott, K. Toischer, H. Milting, P. N. Van, M. Kohlhaas, C. Grebe, A. Kassner, E. Domeier, N. Teucher, et al. Relevance of Brain Natriuretic Peptide in Preload-Dependent Regulation of Cardiac Sarcoplasmic Reticulum Ca2+ ATPase Expression Circulation, June 13, 2006; 113(23): 2724 - 2732. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Chen, M. J. Wood, D. G. Krauser, A. L. Baggish, R. Tung, S. Anwaruddin, M. H. Picard, and J. L. Januzzi NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy Eur. Heart J., April 1, 2006; 27(7): 839 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. van Kimmenade, F. van Dielen, J. Bakker, J. Nijhuis, H. Crijns, W. Buurman, M. van Dieijen-Visser, J.-W. Greve, and Y. Pinto Is Brain Natriuretic Peptide Production Decreased in Obese Subjects? J. Am. Coll. Cardiol., February 21, 2006; 47(4): 886 - 887. [Full Text] [PDF]
|
|
|
|
|
|
A. Nohria and M. M. Givertz B-Type Natriuretic Peptide and the Stressed Heart J. Am. Coll. Cardiol., February 21, 2006; 47(4): 749 - 751. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Januzzi Jr, R. Sakhuja, M. O'Donoghue, A. L. Baggish, S. Anwaruddin, C. U. Chae, R. Cameron, D. G. Krauser, R. Tung, C. A. Camargo Jr, et al. Utility of amino-terminal pro-brain natriuretic Peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med, February 13, 2006; 166(3): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Januzzi, R. van Kimmenade, J. Lainchbury, A. Bayes-Genis, J. Ordonez-Llanos, M. Santalo-Bel, Y. M. Pinto, and M. Richards NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: The International Collaborative of NT-proBNP Study Eur. Heart J., February 1, 2006; 27(3): 330 - 337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Lewin, M. Ledwidge, C. O'Loughlin, C. McNally, and K. McDonald Clinical deterioration in established heart failure: What is the value of BNP and weight gain in aiding diagnosis? Eur J Heart Fail, October 1, 2005; 7(6): 953 - 957. [Abstract] [Full Text] [PDF]
|
|