Acute on chronic heart failure—Which variations on B‐type natriuretic peptide levels? (original) (raw)
Irish Journal of Medical Science, 2011
Aim To examine the prognostic importance of absolute values and change in values of BNP in patients with stable heart failure (HF). Methods Five-hundred and fifty-nine patients attending a disease management programme were categorized into tertiles of BNP (group 1; B95 pg/ml, group 2; 96-249 pg/ml and group 3; C250 pg/ml). A change in BNP between two stable visits was recorded. Patients were followed up for 1 year for death and a composite morbidity measure of HF hospitalization, all-cause hospitalization, unscheduled visits for clinical deterioration(UC) of HF using survival analysis. Results The risk of the combined morbidity outcome increased with increasing tertiles of BNP (Log rank = 17.8 (2), p \ 0.001). Furthermore, a 50 and 25% increase in BNP predicted morbidity in stable HF patients with an initial BNP [ 200 pg/ml (p = 0.02) and [450 pg/ml (p = 0.03), respectively. Conclusion In a stable community HF population, an elevated BNP or an increase in BNP predicts an adverse prognosis thereby potentially identifying a population in need of closer clinical follow-up.
Natriuretic Peptide Testing for Predicting Adverse Events Following Heart Failure Hospitalization
Congestive Heart Failure, 2012
Concentrations of both B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) are useful for diagnostic evaluation of patients with acute decompensated heart failure (ADHF), providing important information regarding presence and severity of heart failure. In addition, levels of both BNP and NT-proBNP are strongly prognostic for adverse outcomes in this setting. While values for BNP and NT-proBNP at hospital admission predict impending risk for adverse outcome, their measurement following HF treatment provides incremental prognostic information, even more accurately identifying patients at highest risk for death or rehospitalization in the short term. Thus, changes in BNP or NT-proBNP following treatment should be considered an important part of the predischarge decision making for patients hospitalized with ADHF.
Clinical Chemistry, 2004
Background: Plasma B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are promising markers for heart failure diagnosis, prognosis, and treatment. Insufficient data on the intraindividual biological variation (CV i ) of BNP and NT-proBNP hamper interpretation of changes in concentration on disease progression or treatment optimization. We therefore investigated CV i values in stable heart failure patients. Methods: We recruited 43 patients with stable chronic heart failure living in Curaçao (22 males, 21 females; median age, 63 years; range, 20 -86 years; New York Heart Association classes I-III). Samples were collected for within-day CV i (n ؍ 6; every 2 h starting at 0800), day-to-day CV i (n ؍ 5; samples collected between 0800 and 1000 on 5 consecutive days) and week-to-week CV i (n ؍ 6; samples collected between 0800 and 1000 on the same day of the week for 6 consecutive weeks). NT-proBNP (Roche) and BNP (Abbott) were measured by immunoassay. Results: Median (range) concentrations were 134 (0 -1630) ng/L (BNP) and 570 (17-5048) ng/L (NT-proBNP). Analytical variation, week-to-week CV i , and reference change values were 8.4%, 40%, and 113% (BNP), and 3.0%, 35%, and 98% (NT-proBNP). Week-to week CV i s were inversely related to median BNP concentrations.
Prognosis of Stage A or B Heart Failure Patients With Elevated B-type Natriuretic Peptide Levels
Journal of Cardiac Failure, 2010
Background: Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients. Methods and Results: Outpatients referred for echocardiogram (n 5 829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100 pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62e2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11e3.28). Conclusions: Individuals without any history of HF but with BNP $100 pg/mL are at equal or higher risk than those with a HF history whose BNP is !100 pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events. (J Cardiac Fail 2010;16:93e98)
BMC cardiovascular disorders, 2016
B-type natriuretic peptide (BNP) levels during admission have been shown to have prognostic value in the diagnosis of heart failure and further predict the in-hospital mortality of acute decompensated heart failure (ADHF). This study describes the characteristics of BNP among hospitalized ADHF and elucidates its prognostic value of in-hospital mortality in an Asian population. We consecutively studied patients aged 20+ who were discharged with a diagnosis of ADHF from March 2013 to March 2014 in a tertiary hospital of northern Taiwan by reviewing medical records. Prognostic predictors of mortality were assessed using Cox proportional hazard regression models. BNP > 100 pg/ml was used as the cut-off for defining abnormally high BNP based on current clinical practice criteria. After implementation of our exclusion criteria, a total of 1,807 patients hospitalized with ADHF were studied. Compared to those subjects with BNP ≤100 pg/ml, individuals with higher BNP tended to have more a...
Wiener klinische Wochenschrift, 2008
Zusammenfassung. Hintergrund: Das B-type natriuretic peptide (BNP) kann bei Patienten mit chronischer, klinisch stabiler Herzinsuffizienz (HI) innerhalb von Tagen eine erhebliche Variation aufweisen. Das Ziel der vorliegenden Studie bestand darin, die klinische Bedeutung dieses Phänomens zu untersuchen. Methodik: BNP wurde bei 23 Patienten mit leichtbis mäßiggradiger, klinisch stabiler systolischer HI (medianes [Interquartilsabstand] Alter 72 [64-77] Jahre, linksventrikuläre Auswurffraktion 30 [27-40]%) und früherer Hospitalisation wegen HI zu zwei Zeitpunkten (T1 and T2, Intervall 5 [3-7] Tage) gemessen. Die Änderung des BNP zwischen T1 and T2 wurde berechnet (∆BNP; unabhängig davon ob BNP abfiel oder anstieg). Die Patienten wurden über 436 (407-458) Tage bezüglich Re-Hospitalisation nachbeobachtet. Resultate: ∆BNP in der gesamten Studienpopulation betrug 26 (9-116) pg/ml (19 [10-28]% des Werts zum Zeitpunkt T1). Während der Nachbeobachtungszeit wurden 8/23 (35%) Patienten re-hospitalisiert. Die BNP-Werte zum Zeitpunkt T1 (340 [187-533] vs. 210 [108-606] pg/ml; p = 0,33) und T2 (328 [125-491] vs. 259 [89-536] pg/ml; p = 0,51) waren vergleichbar bei den Patienten, die re-hospitalisiert wurden und denjenigen, die nicht re-hospitalisiert wurden. ∆BNP war aber höher bei den Patienten, die re-hospitalisiert wurden als bei denjenigen, die nicht re-hospitalisiert wurden (98 [36-186] versus 19 [6-93] pg/ml; p = 0,04). Patienten mit einem ∆BNP < 26 pg/ml hatten ein längeres Re-Hospitalisationsfreies Überleben verglichen mit denjenigen mit einem ∆BNP ≥ 26 pg/ml (log rank p = 0,02). Sensitivität und Spezifität eines ∆BNP ≥ 26 pg/ml zur Vorhersage einer Re-Hospitalisation betrugen 88% und 67%.
Plasma B-type Natriuretic Peptide Levels in Stable Heart Failure Patients
Indian Journal of Medical Biochemistry, 2019
Introduction: Heart failure (HF) is a major and growing public health problem among the global population. Cardiac biomarkers are a promising tool for the early and specific detection of heart failure. B-type natriuretic peptide (BNP) is one such cardiac biomarker released in response to ventricular myocyte stretch. Aim: The aim of the present study was to estimate the levels of plasma BNP in patients with stable chronic heart failure (CHF) and to compare them with controls. Further to correlate the relationship between plasma BNP levels and factors like age, gender and left ventricular ejection fraction (LVEF), in the two groups. Materials and methods: A case-control study conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India consisting of 55 stable CHF patients on treatment and 35 controls. Serum creatinine was estimated adopting modified Jaffe's method. eGFR was calculated using the modification of diet in renal disease (MDRD) formula. Plasma BNP levels were measured by ELISA. Results: The mean BNP concentration in patients with stable CHF was 60.46 ± 16.13 pg/mL, while in controls it was 20.94 ± 5.81pg/mL and the difference was highly significant (p= 0.001). As the age increases an increasing trend in the values of plasma BNP was observed in both groups. There was a strong negative linear relationship (r =-0.798) observed between LVEF and BNP levels in the study population. A cutoff level of 30.2pg/mL for plasma BNP had a 100% sensitivity and specificity to predict CHF. Conclusion: Our study concludes that plasma BNP was significantly higher in patients with stable chronic heart failure than in the controls. Plasma BNP as a biomarker will help in identifying stable CHF patients who are asymptomatic, on their adequacy of treatment.
The American Journal of Emergency Medicine, 2013
Objective: The main objective of this study was to determine a cutoff level of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) that could successfully predict the short-and long-term prognosis of patients with acute heart failure at the time of admission to the emergency department. The results of our study are presented in context with previously published literature. We believe that the present study will be useful and salutary for the progress of literature. Methods: N-terminal pro-B-type natriuretic peptide plasma levels were obtained from 100 patients with shortness of breath and left ventricular dysfunction upon admission to the emergency department. All patients underwent follow-up evaluations 30 days and 1 year after admission. The end point was defined as all-cause mortality. Results: The mean age of the patients in this study was 70.8 ± 11.6 years, and 51% were female. All-cause mortality at the 30-day and 1-year follow-up evaluations was 21.2% and 53.5%, respectively. We determined that the optimal NT-proBNP cutoff point for predicting 30-day mortality at the time of admission was 9152.4 pg/mL, with a 71.4% sensitivity and an 81.3% specificity (95% confidence interval, area under the curve: 0.726; P = .002). The optimal NT-proBNP cutoff point for predicting 1-year mortality at the time of admission was 3630.5 pg/mL, with an 83.0% sensitivity and a 52.2% specificity (95% confidence interval, area under the curve: 0.644; P = .014). Conclusion: Elevated NT-proBNP levels at the time of admission are a strong and independent predictor of allcause mortality in patients with acute heart failure at 30 days and 1 year after admission. Furthermore, the optimal cutoff level of NT-proBNP used to predict 30-day and 1-year mortality had high sensitivity.