Author + information
- Received January 10, 2006
- Revision received May 3, 2006
- Accepted June 5, 2006
- Published online October 17, 2006.
- Roland R.J. van Kimmenade, MD, PhD⁎,
- James L. Januzzi Jr, MD†,⁎ (, )
- Aaron L. Baggish, MD†,
- John G. Lainchbury, MD‡,
- Antoni Bayes-Genis, MD, PhD§,
- A. Mark Richards, MD, PhD‡ and
- Yigal M. Pinto, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. James L. Januzzi, Jr., Massachusetts General Hospital, Yawkey 5800, 55 Fruit Street, Boston, Massachusetts 02114
Objectives We sought to study the individual and integrative role of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and parameters of renal function for prognosis in heart failure.
Background Amino-terminal pro-BNP and renal impairment both predict death in patients with heart failure. Worsening of renal function in heart failure even defines the “cardiorenal syndrome.”
Methods Seven hundred twenty subjects presenting with acute heart failure from 4 university-affiliated medical centers were dichotomized according to NT-proBNP concentration and baseline glomerular filtration rate. In addition, patients were divided according to changes in renal function. The primary end point was 60-day mortality.
Results The combination of a glomerular filtration rate (GFR) <60 ml/min/1.73 m2with an NT-proBNP >4,647 pg/ml was the best predictor of 60-day mortality (odds ratio 3.46; 95% confidence interval 2.13 to 5.63). Among subjects with an NT-proBNP above the median, those with a GFR <60 ml/min/1.73 m2or a creatinine rise ≥0.3 mg/dl had the worst prognosis, whereas in subjects with a NT-proBNP below the median, prognosis was not influenced by either impaired renal function at presentation or the development of renal impairment during admission.
Conclusions The combination of NT-proBNP with measures of renal function better predicts short-term outcome in acute heart failure than either parameter alone. Among heart failure patients, the objective parameter of NT-proBNP seems more useful to delineate the “cardiorenal syndrome” than the previous criteria of a clinical diagnosis of heart failure.
Supported by grants from Roche Diagnostics and the Ed and Maureen Lewi Fund for Cardiovascular Research.
Drs. van Kimmenade and Jannuzzi contributed equally to this work.
- Received January 10, 2006.
- Revision received May 3, 2006.
- Accepted June 5, 2006.
- American College of Cardiology Foundation