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J Am Coll Cardiol, 2006; 48:1808-1812, doi:10.1016/j.jacc.2006.07.037 (Published online 16 October 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

Gender-Specific Risk Stratification With B-Type Natriuretic Peptide Levels in Patients With Acute Dyspnea

Insights From the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation Study

Michael Christ, MD*, Kirsten Laule-Kilian, BSc, Willibald Hochholzer, MD, Theresia Klima, MD, Tobias Breidthardt, MD, Andre P. Perruchoud, MD and Christian Mueller, MD

Department of Internal Medicine, Medical Division A, University Hospital, Basel, Switzerland

Manuscript received April 3, 2006; revised manuscript received July 5, 2006, accepted July 17, 2006.

* Reprint requests and correspondence: Dr. Michael Christ, Medical Division A, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. (Email: MicChrist{at}uhbs.ch).

OBJECTIVES: We examined whether B-type natriuretic peptide (BNP) levels allow gender-specific risk stratification in patients with acute dyspnea.

BACKGROUND: B-type natriuretic peptide levels determined in patients with heart failure correlate with the severity of disease and prognosis. Gender differences in risk prediction are poorly examined.

METHODS: The BASEL (B-type natriuretic peptide for Acute Shortness of Breath Evaluation) Study enrolled 190 female and 262 male patients presenting with acute dyspnea.

RESULTS: At 24 months, cumulative mortality was comparable in women and men (38% vs. 35%, p = 0.66). Cox regression analyses revealed that BNP levels >500 pg/ml indicated a 5.1-fold increase in mortality for women (95% confidence interval [CI] 3.0 to 8.5, p < 0.001) versus a 1.8-fold increase in men (95% CI 1.2 to 2.6; p = 0.007). The area under the receiver-operating characteristic curve (AUC) for BNP to predict death was significantly higher in female (AUC: 0.80, 95% CI 0.73 to 0.86) than in male patients (AUC: 0.64, 95% CI 0.57 to 0.71; p = 0.001 for the comparison of AUCwomen versus AUCmen ). Women with BNP >500 pg/ml displayed a higher mortality as compared with men with BNP >500 pg/ml (68% vs. 46%, p = 0.015). Interaction analysis showed that BNP is a stronger predictor of death in women than in men (p = 0.008).

CONCLUSIONS: B-type natriuretic peptide plasma levels seem to be stronger predictors of death in women than in men.

Abbreviations and Acronyms
  AUC = area under the (receiver-operating characteristic) curve
  BNP = B-type natriuretic peptide
  CI = confidence interval
  HF = heart failure






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