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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

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J. Am. Coll. Cardiol. 2008 51: A35-A36. [Full Text] [PDF]