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J Am Coll Cardiol, 2001; 37:386-391
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: HEART FAILURE

A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study

Van Cheng, BS*, Radmila Kazanagra, MD*, Alex Garcia, LVN*, Leslie Lenert, MD* {dagger}, Padma Krishnaswamy, MD*, Nancy Gardetto, NP*, Paul Clopton, BS* and Alan Maisel, MD, FACC* {dagger}

* Division of Cardiology, Veteran’s Affairs Medical Center, San Diego, California, USA
{dagger} Department of Medicine, University of California, San Diego, California, USA

Manuscript received April 27, 2000; revised manuscript received September 20, 2000, accepted October 26, 2000.

Reprint requests and correspondence: Dr. Alan Maisel, VAMC Cardiology 111-A, 3350 La Jolla Village Drive, San Diego, California 921161
amaisel{at}ucsd.edu

OBJECTIVES

The goal of this study was to determine if B-type natriuretic peptide (BNP) levels predict outcomes of patients admitted with decompensated heart failure.

BACKGROUND

Treatment of decompensated congestive heart failure (CHF) has often been based on titration of drugs to relieve patient’s symptoms, a case that could be made for attempting to also treat neurohormonal abnormalities. Because BNP reflects both elevated left ventricular pressure as well as neurohormonal modulation, we hypothesized that BNP might be useful in assessing outcomes in patients admitted with decompensated CHF.

METHODS

We followed 72 patients admitted with decompensated New York Heart Association class III to IV CHF, measuring daily BNP levels. We then determined the association between initial BNP measurement and the predischarge or premoribund BNP measurement and subsequent adverse outcomes (death and 30-day readmission).

RESULTS

Of the 72 patients admitted with decompensated CHF, 22 end points occurred (death: n = 13, readmission: n = 9). In these patients, BNP levels increased during hospitalization (mean increase, 233 pg/ml, p < 0.001). In patients without end points, BNP decreased (mean decrease 215 pg/ml). Univariate analysis revealed that the last measured BNP was strongly associated with the combined end point. In patients surviving hospitalization, BNP discharge concentrations were strong predictors of subsequent readmission (area under the receiver operator curve of 0.73).

CONCLUSIONS

In patients admitted with decompensated CHF, changes in BNP levels during treatment are strong predictors for mortality and early readmission. The results suggest that BNP levels might be used successfully to guide treatment of patients admitted for decompensated CHF.

Abbreviations and Acronyms
  BNP = B-type natriuretic peptide
  CHF = congestive heart failure
  LV = left ventricle, left ventricular
  NYHA = New York Heart Association
  SEM = standard error of the mean




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R. Hutfless, R. Kazanegra, M. Madani, M. A. Bhalla, A. Tulua-Tata, A. Chen, P. Clopton, C. James, A. Chiu, and A. S. Maisel
Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery
J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1873 - 1879.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
M. Vanderheyden, J. Bartunek, and M. Goethals
Brain and other natriuretic peptides: molecular aspects
Eur J Heart Fail, March 15, 2004; 6(3): 261 - 268.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
V. Kirk, M. Bay, J. Parner, K. Krogsgaard, T.M. Herzog, S. Boesgaard, C. Hassager, O.W. Nielsen, J. Aldershvile, and H. Nielsen
N-terminal proBNP and mortality in hospitalised patients with heart failure and preserved vs. reduced systolic function: data from the prospective Copenhagen Hospital Heart Failure Study (CHHF)
Eur J Heart Fail, March 15, 2004; 6(3): 335 - 341.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
M. Richards and R. W. Troughton
NT-proBNP in heart failure: therapy decisions and monitoring
Eur J Heart Fail, March 15, 2004; 6(3): 351 - 354.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
P. Bettencourt
NT-proBNP and BNP: biomarkers for heart failure management
Eur J Heart Fail, March 15, 2004; 6(3): 359 - 363.
[Abstract] [Full Text] [PDF]

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 ANN INTERN MEDHome page
A. D. Auerbach and J. Kleinbart
Update in Hospital Medicine
Ann Intern Med, March 2, 2004; 140(5): 363 - 369.
[Full Text] [PDF]

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 JCOHome page
S. E. Lipshultz and S. D. Colan
Cardiovascular Trials in Long-Term Survivors of Childhood Cancer
J. Clin. Oncol., March 1, 2004; 22(5): 769 - 773.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
D. Logeart, G. Thabut, P. Jourdain, C. Chavelas, P. Beyne, F. Beauvais, E. Bouvier, and A. C. Solal
Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure
J. Am. Coll. Cardiol., February 18, 2004; 43(4): 635 - 641.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
C. Mueller, A. Scholer, K. Laule-Kilian, B. Martina, C. Schindler, P. Buser, M. Pfisterer, and A. P. Perruchoud
Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea
N. Engl. J. Med., February 12, 2004; 350(7): 647 - 654.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
R. W. Troughton, D. L. Prior, J. J. Pereira, M. Martin, A. Fogarty, A. Morehead, T. G. Yandle, A. M. Richards, R. C. Starling, J. B. Young, et al.
Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function
J. Am. Coll. Cardiol., February 4, 2004; 43(3): 416 - 422.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
M. M. Givertz and E. Braunwald
Neurohormones in heart failure: predicting outcomes, optimizing care
Eur. Heart J., February 2, 2004; 25(4): 281 - 282.
[Full Text] [PDF]

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 ChestHome page
S. de Denus, C. Pharand, and D. R. Williamson
Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone
Chest, February 1, 2004; 125(2): 652 - 668.
[Abstract] [Full Text] [PDF]

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 Am J Crit CareHome page
A. Prahash and T. Lynch
B-Type Natriuretic Peptide: A Diagnostic, Prognostic, and Therapeutic Tool in Heart Failure
Am. J. Crit. Care., January 1, 2004; 13(1): 46 - 53.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
W.H. W. Tang, J. P. Girod, M. J. Lee, R. C. Starling, J. B. Young, F. Van Lente, and G. S. Francis
Plasma B-Type Natriuretic Peptide Levels in Ambulatory Patients With Established Chronic Symptomatic Systolic Heart Failure
Circulation, December 16, 2003; 108(24): 2964 - 2966.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
H. D. White and J. K. French
Use of brain natriuretic peptide levels for risk assessment in non-ST-elevation acute coronary syndromes
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1917 - 1920.
[Full Text] [PDF]

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 Eur Heart JHome page
M.R Cowie, P Jourdain, A Maisel, U Dahlstrom, F Follath, R Isnard, A Luchner, T McDonagh, J Mair, M Nieminen, et al.
Clinical applications of B-type natriuretic peptide (BNP) testing
Eur. Heart J., October 1, 2003; 24(19): 1710 - 1718.
[Abstract] [Full Text] [PDF]

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 Diabetes CareHome page
V. Epshteyn, K. Morrison, P. Krishnaswamy, R. Kazanegra, P. Clopton, S. Mudaliar, S. Edelman, R. Henry, and A. Maisel
Utility of B-Type Natriuretic Peptide (BNP) as a Screen for Left Ventricular Dysfunction in Patients With Diabetes
Diabetes Care, July 1, 2003; 26(7): 2081 - 2087.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
A. S. Maisel, J. McCord, R. M. Nowak, J. E. Hollander, A. H. B. Wu, P. Duc, T. Omland, A. B. Storrow, P. Krishnaswamy, W. T. Abraham, et al.
Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction: Results from the Breathing Not Properly Multinational Study
J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2010 - 2017.
[Abstract] [Full Text] [PDF]

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 Endocr. Rev.Home page
H. Ruskoaho
Cardiac Hormones as Diagnostic Tools in Heart Failure
Endocr. Rev., June 1, 2003; 24(3): 341 - 356.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
B. Bozkurt and D. L. Mann
Use of Biomarkers in the Management of Heart Failure: Are We There Yet?
Circulation, March 11, 2003; 107(9): 1231 - 1233.
[Full Text] [PDF]

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 CirculationHome page
E. O. Weinberg, M. Shimpo, S. Hurwitz, S.-i. Tominaga, J.-L. Rouleau, and R. T. Lee
Identification of Serum Soluble ST2 Receptor as a Novel Heart Failure Biomarker
Circulation, February 11, 2003; 107(5): 721 - 726.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
T. S. Mir, S. Marohn, S. Laer, M. Eiselt, O. Grollmus, and J. Weil
Plasma Concentrations of N-Terminal Pro-Brain Natriuretic Peptide in Control Children From the Neonatal to Adolescent Period and in Children With Congestive Heart Failure
Pediatrics, December 1, 2002; 110(6): e76 - 76.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
D. Logeart, C. Saudubray, P. Beyne, G. Thabut, P.-V. Ennezat, C. Chavelas, C. Zanker, E. Bouvier, and A. C. Solal
Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea
J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1794 - 1800.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
S. Kruger, J.u. Graf, D. Kunz, T. Stickel, P. Hanrath, and U. Janssens
brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure
J. Am. Coll. Cardiol., August 21, 2002; 40(4): 718 - 722.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
P. A. McCullough, R. M. Nowak, J. McCord, J. E. Hollander, H. C. Herrmann, P. G. Steg, P. Duc, A. Westheim, T. Omland, C. W. Knudsen, et al.
B-Type Natriuretic Peptide and Clinical Judgment in Emergency Diagnosis of Heart Failure: Analysis From Breathing Not Properly (BNP) Multinational Study
Circulation, July 23, 2002; 106(4): 416 - 422.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
A. S. Maisel, P. Krishnaswamy, R. M. Nowak, J. McCord, J. E. Hollander, P. Duc, T. Omland, A. B. Storrow, W. T. Abraham, A. H.B. Wu, et al.
Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure
N. Engl. J. Med., July 18, 2002; 347(3): 161 - 167.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
M. Hulsmann, R. Berger, B. Sturm, A. Bojic, W. Woloszczuk, J. Bergler-Klein, and R. Pacher
Prediction of outcome by neurohumoral activation, the six-minute walk test and the Minnesota Living with Heart Failure Questionnaire in an outpatient cohort with congestive heart failure
Eur. Heart J., June 1, 2002; 23(11): 886 - 891.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
A. Maisel
B-Type Natriuretic Peptide Levels: Diagnostic and Prognostic in Congestive Heart Failure: What's Next?
Circulation, May 21, 2002; 105(20): 2328 - 2331.
[Full Text] [PDF]


 
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