Abstract 19283: Incremental Prognostic Value of Discordant Amino Terminal Pro B-type Natriuretic Peptide Compared to B-type Natriuretic Peptide Levels in Stable Patients with Heart Failure
Background: Pro B-type natriuretic peptide is cleaved into amino terminal pro B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP). NT-proBNP has a longer half life than BNP (25-70 vs. 13-20 min, respectively) and, unlike BNP, is biologically inactive. The prognostic significance of discordant NT-proBNP compared to BNP levels is unknown in patients with heart failure.
Hypothesis: We hypothesize that higher a higher difference in NT-proBNP to BNP levels predicts all-cause mortality after adjustment for traditional cardiac risk factors and NT-proBNP or BNP levels.
Methods: We measured the difference between baseline NT-proBNP and BNP levels in 508 sequential stable patients with a history of heart failure who were undergoing elective coronary angiography without acute coronary syndrome, with 5-year follow-up of all-cause mortality. NT-proBNP (Roche), BNP (Abbott), and troponin (hs-cTnT, Roche 5th gen) were measured. Glomerular filtration rate (GFR) was estimated by MDRD equation.
Results: In our study cohort (mean age 67±11 years, 63% male, 36% diabetic, median NT-proBNP 1025 pg/mL and median BNP 306 pg/mL) the median NT-proBNP-BNP difference was 677 pg/mL (interquartile range 227-1915 pg/mL) and 166 subjects died over 5-years. High NT-proBNP-BNP was associated with a 4.5-fold increase in 5-year mortality risk (Quartile 4 versus 1: Hazard ratio [95% confidence interval] 3.45 [2.78-7.44], p<0.0001, Figure). After adjusting for traditional risk factors, LVEF, hs-cTnT, BNP and NT-proBNP, high NT-proBNP-BNP still conferred a 2.2-fold increase in mortality risk (2.17 [1.13-4.27], p=0.02).
Conclusions: A higher discrepancy in NT-proBNP to BNP provided independent and incremental prognostic value for mortality prediction beyond their individual levels in chronic heart failure. These findings support the hypothesis that chronic cleavage and impaired clearance of natriuretic peptides is maladaptive in heart failure.
Author Disclosures: J.L. Grodin: None. M. Hammadah: None. S.L. Hazen: None. W.W. Tang: None.
- © 2014 by American Heart Association, Inc.