HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.02.037v1 49/19/1943    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Fonarow, G. C. Search for Related Content PubMed Articles by Fonarow, G. C.

CLINICAL RESEARCH: HEART FAILURE

Admission B-Type Natriuretic Peptide Levels and In-Hospital Mortality in Acute Decompensated Heart Failure

Gregg C. Fonarow, MD, FACC^_*,_*, William F. Peacock, MD, Christopher O. Phillips, MD, MPH, Michael M. Givertz, MD, FACC, Margarita Lopatin, MS^|| for the ADHERE Scientific Advisory Committee and Investigators

^_* Ahmanson–UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California
Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
Department of Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
^|| Department of Biostatistics, Scios Inc., Mountain View, California.

Manuscript received November 20, 2006; revised manuscript received January 3, 2007, accepted February 5, 2007.

^_* Reprint requests and correspondence: Dr. Gregg C. Fonarow, University of California, Los Angeles, Division of Cardiology, 10833 Le Conte Avenue, Los Angeles, California 90095. (Email: gfonarow{at}mednet.ucla.edu).

Objectives: This study was designed to determine whether admission B-type natriuretic peptide (BNP) levels are predictive of in-hospital mortality in acute decompensated heart failure (HF).

Background: Levels of BNP have been demonstrated to facilitate the diagnosis of HF and predict mortality in chronic systolic HF.

Methods: B-type natriuretic peptide levels within 24 h of presentation were obtained in 48,629 (63%) of 77,467 hospitalization episodes entered in ADHERE (Acute Decompensated Heart Failure National Registry). In-hospital mortality was assessed by BNP quartiles in the entire cohort and in patients with reduced (n = 19,544) as well as preserved (n = 18,164) left ventricular systolic function using chi-square and logistic regression models.

Results: Quartiles (Q) of BNP were Q1 (<430), Q2 (430 to 839), Q3 (840 to 1,729), and Q4 (1,730 pg/ml). The BNP levels were <100 pg/ml in 3.3% of the total cohort. Patients in Q1 versus Q4 were younger, more likely to be women, and had lower creatinine and higher left ventricular ejection fraction. There was a near-linear relationship between BNP quartiles and in-hospital mortality: Q1 (1.9%), Q2 (2.8%), Q3 (3.8%), and Q4 (6.0%), p < 0.0001. B-type natriuretic peptide quartile remained highly predictive of mortality even after adjustment for age, gender, systolic blood pressure, blood urea nitrogen, creatinine, sodium, pulse, and dyspnea at rest, Q4 versus Q1 (adjusted odds ratio 2.23 [95% confidence interval 1.91 to 2.62, p < 0.0001]). The BNP quartiles independently predicted mortality in patients with reduced and preserved systolic function.

Conclusions: An elevated admission BNP level is a significant predictor of in-hospital mortality in acute decompensated HF with either reduced or preserved systolic function, independent of other clinical and laboratory variables. (Registry for Acute Decompensated Heart Failure Patients; http://www.clinicaltrials.gov/show/NCT00366639; NCT00366639 [ClinicalTrials.gov] ).

Abbreviations and Acronyms   BMI = body mass index   BNP = B-type natriuretic peptide   BUN = blood urea nitrogen   HF = heart failure   LV = left ventricular   LVEF = left ventricular ejection fraction   NT-proBNP = N-terminal pro-B-type natriuretic peptide   Q = quartile

This article has been cited by other articles:

				A. S. Maisel, W. F. Peacock, N. McMullin, R. Jessie, G. C. Fonarow, J. Wynne, and R. M. Mills Timing of Immunoreactive B-Type Natriuretic Peptide Levels and Treatment Delay in Acute Decompensated Heart Failure: An ADHERE (Acute Decompensated Heart Failure National Registry) Analysis J. Am. Coll. Cardiol., August 12, 2008; 52(7): 534 - 540. [Abstract] [Full Text] [PDF]

				L. B. Daniels, G. A. Laughlin, P. Clopton, A. S. Maisel, and E. Barrett-Connor Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older Adults: Results From the Rancho Bernardo Study J. Am. Coll. Cardiol., August 5, 2008; 52(6): 450 - 459. [Abstract] [Full Text] [PDF]

				A L Baggish, D M Lloyd-Jones, J Blatt, A M Richards, J Lainchbury, M O'Donoghue, R Sakhuja, A A Chen, and J L Januzzi A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: derivation, validation and incorporation into a bedside programme Heart, August 1, 2008; 94(8): 1032 - 1037. [Abstract] [Full Text] [PDF]

				M. Nishii, T. Inomata, H. Takehana, T. Naruke, T. Yanagisawa, M. Moriguchi, S. Takeda, and T. Izumi Prognostic utility of B-type natriuretic peptide assessment in stable low-risk outpatients with nonischemic cardiomyopathy after decompensated heart failure. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2329 - 2335. [Abstract] [Full Text] [PDF]

				R. M. Mills Learning to use a biomarker. More about B-type natriuretic peptide. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2336 - 2338. [Full Text] [PDF]

				E. Braunwald Biomarkers in Heart Failure N. Engl. J. Med., May 15, 2008; 358(20): 2148 - 2159. [Full Text] [PDF]

				L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]

				W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., December 11, 2007; 50(24): 2344 - 2351. [Full Text] [PDF]

				BNP Level Predicts Mortality in Acute Decompensated Heart Failure Journal Watch Emergency Medicine, June 1, 2007; 2007(601): 1 - 1. [Full Text]