Abstract 2383: Baseline Atrial Natriuretic Peptide is the Best Predictor of Long-Term Survival in Chronic Heart Failure: a 15-Year Prospective Follow-Up Study
Background. Elevated natriuretic peptide levels are associated with congestive heart failure (CHF), and have been shown to be a good predictor of prognosis. However, the very-long-term prognostic value of natriuretic peptides in the context of other candidate predictors has not been previously assessed in patients with CHF.
Methods. One-hundred and six consecutive outpatients with CHF (85 M and 21 F, median age 56 y) were followed for 15 years. Echocardiographic tracings and blood samples were collected at study entry to evaluate cardiac function, atrial natriuretic peptide (ANP), plasma renin activity (PRA) and aldosterone. The relationship between neurohormones and clinical/echocardiographic variables and mortality were assessed.
Results. After 15 years, 86 of the 106 patients (81%) had died. Multivariable analysis shows that plasma ANP is the best independent predictor of survival over a number of clinical, echocardiographic and neurohormonal variables (HR: 4.01; 95% CI, 2.14–7.51; p<0.001), including age, diabetes, CHF aetiology, NYHA class, left ventricular diameter and EF, heart rate, use of diuretics, aldosterone, and PRA.
Conclusions. The present study represents the longest available follow up of CHF patients evaluating neurohormones, clinical and cardiac function parameters. We here show that plasma ANP is the most powerful long-term predictor of mortality in CHF.