Author + information
- Received April 10, 2007
- Revision received December 10, 2007
- Accepted December 11, 2007
- Published online May 13, 2008.
- Stephen W. Waldo, MD⁎,†,
- Jennifer Beede, MS⁎,
- Susan Isakson, BS⁎,
- Sylvie Villard-Saussine, PhD‡,
- Jeannette Fareh, PhD‡,
- Paul Clopton, MS⁎,
- Robert L. Fitzgerald, PhD⁎ and
- Alan S. Maisel, MD, FACC⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Alan S. Maisel, Veterans Affairs San Diego Healthcare System, Cardiology 9111-A, 3350 La Jolla Village Drive, San Diego, California 92161.
Objectives The present study sought to evaluate the clinical utility of pro-B-type natriuretic peptides (proBNP) in patients admitted with acute decompensated heart failure.
Background Plasma natriuretic peptides (BNP1–32, N-terminal [NT]-proBNP1–76) have been demonstrated to assist in the diagnosis of patients with heart failure. However, the precursor to these polypeptides (proBNP1–108) circulates in plasma and may interfere with the measurement of currently used biomarkers.
Methods Plasma natriuretic peptides were assessed in 164 individuals (99% men) hospitalized with decompensated heart failure. The B-type natriuretic peptide (BNP), NT-proBNP, and proBNP levels at hospital admission and discharge were compared with the incidence of cardiac death and all-cause mortality within 90 days post-discharge.
Results Pro-B-type natriuretic peptides demonstrated a high degree of correlation with both BNP (R = 0.924, p < 0.001) and NT-proBNP (R = 0.802, p < 0.001) at admission. Further characterization of proBNP demonstrated little variation with changes in age, body mass index, creatinine, or systolic dysfunction. All 3 plasma natriuretic peptides were significantly elevated at admission in patients suffering a cardiac death or all-cause mortality (p < 0.05). Receiver-operating characteristic curves demonstrated that admission and discharge NT-proBNP (area under the curve [AUC] 0.788 and AUC 0.834) had superior prognostic power for all-cause mortality when compared with BNP (AUC 0.644, p < 0.01 and AUC 0.709, p < 0.01) and proBNP (AUC 0.653, p < 0.01 and AUC 0.666, p < 0.01) at the same time points.
Conclusions Admission values of all natriuretic peptides can be used to predict cardiac death and all-cause mortality. A preliminary comparison suggests that discharge values of NT-proBNP have the greatest diagnostic yield for predicting these end points. Further studies should explore the synergistic prognostic potential of all natriuretic peptides.
Margaret Redfield, MD, served as Guest Editor for this article.
- Received April 10, 2007.
- Revision received December 10, 2007.
- Accepted December 11, 2007.
- American College of Cardiology Foundation