NT-ProBNP Change Prognostic in Acute HF

March 04, 2011

March 4, 2011 (Baltimore, Maryland) — A <50% drop in natriuretic peptides during hospitalization for acute heart failure points to greater risk of death or rehospitalization within a year, suggests a prospective cohort study [1].

The prognostic power of such a change in N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels was independent of a range of more standard risk indicators, such as admission creatinine, LVEF, and comorbidities, according to the authors, led by Dr Henry J Michtalik (Johns Hopkins University School of Medicine, Baltimore, MD).

"This suggests that NT-proBNP could be a summary marker for many different variables, including HF severity, ischemia, hypertension with left ventricular hypertrophy, atrial fibrillation, and valvular disease," the group writes in a report published online February 4, 2011 in the American Journal of Cardiology. "The use of a single objective biomarker to account for multiple mechanisms of disease could benefit the care of a typical patient with HF who has many different comorbidities and risk factors."

The findings are consistent with a post hoc analysis of the SURVIVE trial, previously reported by heartwire , in which a natriuretic peptide drop of >30% independently predicted a nearly 50% decline in six-month mortality.

In the current study, 217 patients admitted with acute heart failure included 120 whose NT-proBNP levels changed by <50% during the hospitalization and 97 with changes of at least 50%; the cutoffs were prospective defined. Discharge for each patient was decided by a clinician who was blinded to discharge NT-proBNP levels.

The rate of readmission or death reached 3.2 and 2.2 per 1000 person-days, respectively. The hazard ratio for that end point at one year for those with a <50% change in the biomarker was 1.54 (95% CI 1.05–2.27, p=0.03), with adjustment for age, sex, race, admission creatinine and NT-proBNP levels, comorbidities (including hypertension, diabetes, CAD, atrial arrhythmias, chronic obstructive pulmonary disease, and peripheral vascular disease), and duration of index hospitalization.

A next step, according to the authors, might be a randomized trial of whether treatments aimed at pushing natriuretic peptide levels down by at least 50% at hospitalization improves postdischarge outcomes.

According to the paper, "the study was supported by an investigator-initiated grant . . .  from Siemens Healthcare Diagnostics."

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