Failing heart—medical aspect
Incremental Value of N-terminal Pro–Brain Natriuretic Peptide Over Left Ventricle Ejection Fraction and Aerobic Capacity for Estimating Prognosis in Heart Failure Patients

https://doi.org/10.1016/j.healun.2008.07.030Get rights and content

Background

N-terminal pro–brain natriuretic peptide (NT-proBNP) plasma levels have been associated with indices of left ventricular (LV) function and aerobic capacity in heart failure.

Methods

We prospectively followed-up 149 patients with impaired left ventricular function for 30 ± 10 months. During this period, 22 patients died and 5 underwent heart transplantation. Blood samples for NT-proBNP assessment were taken at baseline and before cardiopulmonary exercise to estimate peak oxygen consumption (Vo2). LV cavity diameter, left atrial size and LV ejection fraction (LVEF) were measured by echocardiography.

Results

NT-proBNP plasma levels >1,164 pg/ml showed 85% sensitivity and 82% specificity for detecting Vo2<14 ml/kg/min (area under the curve [AUC] = 90%, p < 0.001). Patients above this cutoff showed a 13.6-fold greater hazard ratio compared with those with values below this cutoff (p < 0.001). NT-proBNP plasma levels of >760 pg/ml showed 77% sensitivity and 69% specificity for detecting LVEF <28% (AUC = 77%, p < 0.001). Patients with values above this cutoff showed a 15.85-fold greater hazard ratio compared to those with values below this cutoff (p < 0.001). The addition of NT-proBNP to an assessment model that includes peak Vo2, LVEF and New York Heart Association (NYHA) classification can significantly improve predictive ability.

Conclusions

Assessment of NT-proBNP should be performed to detect candidates for heart transplantation because of the useful prognostic information that it can provide.

Section snippets

Methods

All patients included in this study were recruited from a single center (Onassis Cardiac Surgery Center, Athens, Greece) during the period from September 2003 to March 2007. We prospectively studied 160 patients (130 men and 30 women) diagnosed with LV dysfunction due to coronary artery disease, dilated cardiomyopathy and valvular heart disease. Patients were either post-operative cases or being evaluated for cardiac surgery during entry into our heart failure program. For the patients with

Results

From a total of 160 patients, 11 dropped out due to poor attendance. Thus, a total of 149 subjects, 122 men and 27 women, were included in the analysis.

During the follow-up period (median 30 months, range 3 to 50), 5 subjects underwent heart transplantation and 22 died. Patients' demographic and clinical characteristics are shown in Table 1.

Discussion

Peak Vo2 derived from treadmill cardiopulmonary exercise testing is an objective estimator of severity of heart failure. In our study NT-proBNP correlated strongly with Vo2 peak. Moreover, we found that NT-proBNP levels can be used to identify CHF patients traditionally considered candidates for HT (peak Vo2 <14 ml/kg/min, peak Vo2 <10 ml/kg/min, LVEF <28%17, 18). Recent studies are consistent with our findings with regard to the ability of BNP to predict functional capacity and ventilatory

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