Plasma natriuretic peptides were assessed in 164 unique individuals admitted for decompensated congestive heart failure. The scatter plots above demonstrate that pro-B-type natriuretic peptide (proBNP) at admission is highly correlated with both B-type natriuretic peptide (R = 0.924, p < 0.001) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (R = 0.802, p < 0.001) at the same time point. This correlation was consistent at all time points assessed during a mean hospital stay of 5.5 ± 7.1 days (data not shown).

Plasma B-type natriuretic peptides were compared with the characteristics of the 164 unique individuals hospitalized for congestive heart failure (CHF). The box and whisker plots in A and B demonstrate that pro-B-type natriuretic peptide (proBNP) is independent of age and body mass index (BMI). Panel C suggests that proBNP levels are also independent of serum creatinine and corresponding renal insufficiency. Panel D demonstrates that proBNP levels are unchanged in patients with systolic or diastolic dysfunction.

Admission and discharge plasma natriuretic peptide levels were evaluated in patients that met the primary end point. The box and whisker plots in A demonstrate that patients that suffered a cardiac death (gray boxes) had significantly higher plasma natriuretic peptide levels at admission compared with those that did not have an event (open boxes) within 90 days of hospital discharge. Panel B demonstrates that B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptides (NT-proBNP) levels were also significantly elevated at discharge in patients suffering a cardiac death (gray boxes) when compared with those that did not (open boxes).

Admission and discharge proBNP levels were evaluated in patients that met the secondary end point. The box and whisker plots in A demonstrate that patients that suffered all-cause mortality (gray boxes) within 90 days of hospital discharge had significantly higher natriuretic peptide levels at admission compared with those that survived (open boxes). Panel B demonstrates that all 3 natriuretic peptides were also significantly elevated at discharge in patients suffering all-cause mortality (gray boxes) when compared with those that did not meet the secondary end point (open boxes). BNP = B-type natriuretic peptide; other abbreviations as in Figure 1.

The plasma natriuretic peptide levels at admission were divided into tertiles and compared with the primary and secondary end points. The Kaplan-Meyer curve in panel A demonstrates that patients admitted with a pro-B-type natriuretic peptide (proBNP) level <1,400 pg/ml had significantly fewer cardiac deaths compared with patients in the other tertiles within the follow-up period (p < 0.05). Panel B demonstrates that patients admitted with a proBNP level <1,400 pg/ml had significantly fewer all-cause deaths within the follow-up period than those with an admission proBNP value >4,550 pg/ml (p < 0.05).

The admission and discharge natriuretic peptides were assessed for their ability to predict the incidence of the primary end point and secondary end points. Panel A summarizes the relationship between all natriuretic peptides and cardiac death. As demonstrated in the figure, discharge values of NT-proBNP and proBNP had the greatest prognostic potential (p < 0.05). Panel B summarizes the relationship between natriuretic peptides and all-cause mortality. Once again, the admission and discharge values of NT-proBNP had the greatest prognostic potential (p < 0.01). AUC = area under the curve; BNP = B-type natriuretic peptide; CI = confidence interval; other abbreviations as in Figure 1.