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CLINICAL RESEARCH: HEART FAILURE

Prognostic Utility of B-Type Natriuretic Peptide Assessment in Stable Low-Risk Outpatients With Nonischemic Cardiomyopathy After Decompensated Heart Failure

Department of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan.

Manuscript received August 22, 2007; revised manuscript received October 18, 2007, accepted November 28, 2007.

^_* Reprints requests and correspondence: Dr. Mototsugu Nishii, Department of Cardio-angiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, 228-8555 Kanagawa, Japan. (Email: mototsugu555{at}yahoo.co.jp).

Objectives: We investigated the clinical utility of B-type natriuretic peptide (BNP) assay in stable outpatients with nonischemic dilated cardiomyopathy (NICM) after decompensated heart failure (HF).

Background: Patients with NICM admitted for decompensated HF frequently experience sudden death or redecompensation after hospital discharge. The prognostic value of BNP during hospitalization has been demonstrated. However, clinical utility of BNP in stable outpatient setting has been poorly investigated.

Methods: Eighty-three NICM outpatients who were clinically stable in New York Heart Association functional class 1 to 2 for 6 months after discharge for decompensated HF were enrolled, and then followed for an additional 18 months. The main end point was first readmission for decompensated HF or death. B-type natriuretic peptide levels were measured at 3-month intervals from discharge to enrollment, and echocardiographic dimensions at discharge and enrollment.

Results: Mean discharge BNP level was 210 ± 148 pg/ml. Twenty-eight patients were readmitted for decompensated HF or suddenly died at a median time of 11 months from the time of discharge. Among various variables including BNP measurements, clinical parameters and echocardiographic dimensions, a 6-month post-discharge BNP of >190 pg/ml was most closely associated with combined event in the Cox proportional hazards model (hazard ratio 2.29; 95% confidence interval 1.42 to 3.56; p = 0.0005), and had the best discriminatory power (area under the receiver operating characteristic curve 0.91, sensitivity 96%; specificity 76%).

Conclusions: Even in stable low-risk outpatients with NICM at 6 months after hospital discharge for decompensated HF, BNP assessment predicts a long-term risk of redecompensation.

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ARB = angiotensin receptor blocker   BNP = B-type natriuretic peptide   CI = confidence interval   HF = heart failure   HR = hazard ratio   LADd = left atrial diastolic dimension   LV = left ventricle/ventricular   LVDd = left ventricular end-diastolic dimension   LVEF = left ventricular ejection fraction   NICM = nonischemic dilated cardiomyopathy   NYHA = New York Heart Association

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