This Article Figures Only Full Text Full Text (PDF) 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 PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (16) Citing Articles via Google Scholar Google Scholar Articles by Waldo, S. W. Articles by Maisel, A. S. Search for Related Content PubMed PubMed Citation Articles by Waldo, S. W. Articles by Maisel, A. S. Related Collections Related Article

CLINICAL RESEARCH: HEART FAILURE

Pro-B-Type Natriuretic Peptide Levels in Acute Decompensated Heart Failure

Stephen W. Waldo, MD^_*,, Jennifer Beede, MS^_*, Susan Isakson, BS^_*, Sylvie Villard-Saussine, PhD, Jeannette Fareh, PhD, Paul Clopton, MS^_*, Robert L. Fitzgerald, PhD^_* and Alan S. Maisel, MD, FACC^_*,_*

^_* University of California at San Diego, Veterans Affairs San Diego Healthcare System, San Diego, California
University of California at San Diego School of Medicine, San Diego, California
CNRS FRE3009, Faculty of Pharmacy, Montpellier, France.

Manuscript received April 10, 2007; revised manuscript received December 10, 2007, accepted December 11, 2007.

^_* Reprint requests and correspondence: Dr. Alan S. Maisel, Veterans Affairs San Diego Healthcare System, Cardiology 9111-A, 3350 La Jolla Village Drive, San Diego, California 92161. (Email: amaisel{at}ucsd.edu).

Objectives: The present study sought to evaluate the clinical utility of pro-B-type natriuretic peptides (proBNP) in patients admitted with acute decompensated heart failure.

Background: Plasma natriuretic peptides (BNP_{1– 32}, N-terminal [NT]-proBNP_1–76) have been demonstrated to assist in the diagnosis of patients with heart failure. However, the precursor to these polypeptides (proBNP_1–108) circulates in plasma and may interfere with the measurement of currently used biomarkers.

Methods: Plasma natriuretic peptides were assessed in 164 individuals (99% men) hospitalized with decompensated heart failure. The B-type natriuretic peptide (BNP), NT-proBNP, and proBNP levels at hospital admission and discharge were compared with the incidence of cardiac death and all-cause mortality within 90 days post-discharge.

Results: Pro-B-type natriuretic peptides demonstrated a high degree of correlation with both BNP (R = 0.924, p < 0.001) and NT-proBNP (R = 0.802, p < 0.001) at admission. Further characterization of proBNP demonstrated little variation with changes in age, body mass index, creatinine, or systolic dysfunction. All 3 plasma natriuretic peptides were significantly elevated at admission in patients suffering a cardiac death or all-cause mortality (p < 0.05). Receiver-operating characteristic curves demonstrated that admission and discharge NT-proBNP (area under the curve [AUC] 0.788 and AUC 0.834) had superior prognostic power for all-cause mortality when compared with BNP (AUC 0.644, p < 0.01 and AUC 0.709, p < 0.01) and proBNP (AUC 0.653, p < 0.01 and AUC 0.666, p < 0.01) at the same time points.

Conclusions: Admission values of all natriuretic peptides can be used to predict cardiac death and all-cause mortality. A preliminary comparison suggests that discharge values of NT-proBNP have the greatest diagnostic yield for predicting these end points. Further studies should explore the synergistic prognostic potential of all natriuretic peptides.

Abbreviations and Acronyms   AUC = area under the curve   BMI = body mass index   BNP = B-type natriuretic peptide   NT-proBNP = N-terminal pro-B-type natriuretic peptide   proBNP = pro-B-type natriuretic peptide   ROC = receiver-operating characteristic

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A35-A36. [Full Text] [PDF]

This article has been cited by other articles:

				T. Nishikimi, M. Ikeda, Y. Takeda, T. Ishimitsu, I. Shibasaki, H. Fukuda, H. Kinoshita, Y. Nakagawa, K. Kuwahara, and K. Nakao The effect of glycosylation on plasma N-terminal proBNP-76 levels in patients with heart or renal failure Heart, January 15, 2012; 98(2): 152 - 161. [Abstract] [Full Text] [PDF]

				R. D. Kociol, J. R. Horton, G. C. Fonarow, E. M. Reyes, L. K. Shaw, C. M. O'Connor, G. M. Felker, and A. F. Hernandez Admission, Discharge, or Change in B-Type Natriuretic Peptide and Long-Term Outcomes: Data From Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) Linked to Medicare Claims Circ Heart Fail, September 1, 2011; 4(5): 628 - 636. [Abstract] [Full Text] [PDF]

				W. L. Miller, M. A. Phelps, C. M. Wood, U. Schellenberger, A. Van Le, R. Perichon, and A. S. Jaffe Comparison of Mass Spectrometry and Clinical Assay Measurements of Circulating Fragments of B-Type Natriuretic Peptide in Patients With Chronic Heart Failure Circ Heart Fail, May 1, 2011; 4(3): 355 - 360. [Abstract] [Full Text] [PDF]

				K. Thygesen, J. Mair, C. Mueller, K. Huber, M. Weber, M. Plebani, Y. Hasin, L. M. Biasucci, E. Giannitsis, B. Lindahl, et al. Recommendations for the use of natriuretic peptides in acute cardiac care: A position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care Eur. Heart J., February 2, 2011; (2011) ehq509v1. [Full Text] [PDF]

				Y. Xue, P. Clopton, W. F. Peacock, and A. S. Maisel Serial changes in high-sensitive troponin I predict outcome in patients with decompensated heart failure Eur J Heart Fail, January 1, 2011; 13(1): 37 - 42. [Abstract] [Full Text] [PDF]

				T. Ichiki, B. K. Huntley, D. M. Heublein, S. M. Sandberg, P. M. McKie, F. L. Martin, M. Jougasaki, and J. C. Burnett Jr. Corin Is Present in the Normal Human Heart, Kidney, and Blood, with Pro-B-Type Natriuretic Peptide Processing in the Circulation Clin. Chem., January 1, 2011; 57(1): 40 - 47. [Abstract] [Full Text] [PDF]

				H. Uthoff, C. Thalhammer, M. Potocki, T. Reichlin, M. Noveanu, M. Aschwanden, D. Staub, N. Arenja, T. Socrates, R. Twerenbold, et al. Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure Eur J Heart Fail, May 1, 2010; 12(5): 469 - 476. [Abstract] [Full Text] [PDF]

				T. Nishikimi, N. Minamino, M. Ikeda, Y. Takeda, K. Tadokoro, I. Shibasaki, H. Fukuda, Y. Horiuchi, S. Oikawa, T. Ieiri, et al. Diversity of molecular forms of plasma brain natriuretic peptide in heart failure--different proBNP-108 to BNP-32 ratios in atrial and ventricular overload Heart, March 1, 2010; 96(6): 432 - 439. [Abstract] [Full Text] [PDF]

				P. Srisawasdi, S. Vanavanan, C. Charoenpanichkit, and M. H. Kroll The Effect of Renal Dysfunction on BNP, NT-proBNP, and Their Ratio Am J Clin Pathol, January 1, 2010; 133(1): 14 - 23. [Abstract] [Full Text] [PDF]

				S. Neuhold, M. Huelsmann, G. Strunk, J. Struck, C. Adlbrecht, G. Gouya, M. Elhenicky, and R. Pacher Prognostic Value of Emerging Neurohormones in Chronic Heart Failure during Optimization of Heart Failure-Specific Therapy Clin. Chem., January 1, 2010; 56(1): 121 - 126. [Abstract] [Full Text] [PDF]

				J. E. Rame, S. W. Tam, D. McNamara, M. Worcel, M. L. Sabolinski, A. H. Wu, and D. L. Dries Dysfunctional Corin I555(P568) Allele Is Associated With Impaired Brain Natriuretic Peptide Processing and Adverse Outcomes in Blacks With Systolic Heart Failure: Results From the Genetic Risk Assessment in Heart Failure Substudy Circ Heart Fail, November 1, 2009; 2(6): 541 - 548. [Abstract] [Full Text] [PDF]

				D. Bolliger, M. D. Seeberger, and M. Filipovic Pre-Operative Cardiac Risk Assessment in Noncardiac Surgery: Are Natriuretic Peptides the Magic Bullet? J. Am. Coll. Cardiol., October 20, 2009; 54(17): 1607 - 1608. [Full Text] [PDF]