Prognostic Utility of B-Type Natriuretic Peptide Assessment in Stable Low-Risk Outpatients With Nonischemic Cardiomyopathy After Decompensated Heart Failure
Mototsugu Nishii, PhD, MD*,
Takayuki Inomata, PhD, MD,
Hitoshi Takehana, PhD, MD,
Takashi Naruke, MD,
Tomoyoshi Yanagisawa, MD,
Masahiko Moriguchi, PhD, MD,
Sadao Takeda, PhD, MD and
Tohru Izumi, PhD, MD
Department of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan.
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Figure 1 ROC Curve for Cutoff Values of BNP Levels at 6 Months Post-Discharge
A B-type natriuretic peptide (BNP) level of 190 pg/ml had the best compromise between sensitivity (96%) and specificity (76%) for predicting readmission for decompensated heart failure or sudden death. ROC = receiver-operating characteristic. Area under curve = 0.91.
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Figure 2 Kaplan-Meier Analyses
Kaplan-Meier curves showing the incidence rate of readmission for decompensated heart failure or sudden death (A) or of readmission alone (B) according to 6-month post-discharge B-type natriuretic peptide (BNP) ranges. B-type natriuretic peptide ranges were <190 (the best cutoff level for predicting readmission or sudden death), 190 to 380, and >380 (its 2-fold level) pg/ml. p < 0.0001 (the log-rank test) versus a BNP range of <190 pg/ml.
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Figure 3 Changes in BNP Levels and Echocardiographic Findings During a Clinically Compensated Status
Changes in B-type natriuretic peptide (BNP) at 3-month intervals after hospital discharge (A) and in echocardiographic variables between discharge and 6 months (B). Solid or open circles indicate BNP levels, echocardiographic dimensions (left ventricular end-diastolic dimension [LVDd]; left atrial diastolic dimension [LADd]), and left ventricular ejection fraction (LVEF) in event-free patients or patients readmitted for decompensated heart failure, respectively. Values are mean ± standard error of the mean. p values comparing changes in BNP and echocardiographic variables between readmitted patients and event-free patients are for repeated measures multivariate analysis of variance over 6 months.
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