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CLINICAL RESEARCH: HEART FAILURE

Gender-Specific Risk Stratification With B-Type Natriuretic Peptide Levels in Patients With Acute Dyspnea

Insights From the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation Study

Department of Internal Medicine, Medical Division A, University Hospital, Basel, Switzerland

Manuscript received April 3, 2006; revised manuscript received July 5, 2006, accepted July 17, 2006.

^_* Reprint requests and correspondence: Dr. Michael Christ, Medical Division A, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. (Email: MicChrist{at}uhbs.ch).

OBJECTIVES: We examined whether B-type natriuretic peptide (BNP) levels allow gender-specific risk stratification in patients with acute dyspnea.

BACKGROUND: B-type natriuretic peptide levels determined in patients with heart failure correlate with the severity of disease and prognosis. Gender differences in risk prediction are poorly examined.

METHODS: The BASEL (B-type natriuretic peptide for Acute Shortness of Breath Evaluation) Study enrolled 190 female and 262 male patients presenting with acute dyspnea.

RESULTS: At 24 months, cumulative mortality was comparable in women and men (38% vs. 35%, p = 0.66). Cox regression analyses revealed that BNP levels >500 pg/ml indicated a 5.1-fold increase in mortality for women (95% confidence interval [CI] 3.0 to 8.5, p < 0.001) versus a 1.8-fold increase in men (95% CI 1.2 to 2.6; p = 0.007). The area under the receiver-operating characteristic curve (AUC) for BNP to predict death was significantly higher in female (AUC: 0.80, 95% CI 0.73 to 0.86) than in male patients (AUC: 0.64, 95% CI 0.57 to 0.71; p = 0.001 for the comparison of AUC_women versus AUC_men). Women with BNP >500 pg/ml displayed a higher mortality as compared with men with BNP >500 pg/ml (68% vs. 46%, p = 0.015). Interaction analysis showed that BNP is a stronger predictor of death in women than in men (p = 0.008).

CONCLUSIONS: B-type natriuretic peptide plasma levels seem to be stronger predictors of death in women than in men.

Abbreviations and Acronyms   AUC = area under the (receiver-operating characteristic) curve   BNP = B-type natriuretic peptide   CI = confidence interval   HF = heart failure

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