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N‐terminal brain natriuretic peptide is a more powerful predictor of mortality than endothelin‐1, adrenomedullin and tumour necrosis factor‐α in patients referred for consideration of cardiac transplantation
Author(s) -
Gardner Roy S.,
Chong Victor,
Morton Iain,
McDonagh Theresa A.
Publication year - 2005
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2004.06.002
Subject(s) - medicine , interquartile range , heart failure , transplantation , natriuretic peptide , heart transplantation , cardiology , adrenomedullin , clinical endpoint , brain natriuretic peptide , univariate analysis , gastroenterology , multivariate analysis , randomized controlled trial , receptor
Background: The selection of patients for cardiac transplantation is notoriously difficult. We have demonstrated that N‐terminal brain natriuretic peptide (NT‐proBNP) is a powerful predictor of mortality in advanced heart failure and is superior to the traditional markers of chronic heart failure (CHF) severity. However, the comparative prognostic power of endothelin‐1 (Et‐1), adrenomedullin (Adm) and tumour necrosis factor‐alpha (TNF‐α) in this patient group is unknown. Methods and results: We prospectively studied 150 consecutive patients with advanced CHF referred for consideration of cardiac transplantation. Blood samples for NT‐proBNP, Et‐1, Adm and TNF‐α analysis were taken at recruitment and patients followed up for a median of 666 days. The primary endpoint of all‐cause mortality was reached in 25 patients and the secondary endpoint of all‐cause mortality or urgent cardiac transplantation in 29 patients. The median values for NT‐proBNP, Et‐1, Adm and TNF‐α were 1494 pg/ml [interquartile range 530−3930], 0.39 fmol/ml [0.10−1.24], 94 pg/ml [54−207] and 2.0 pg/ml [0−18.5] respectively. The only univariate and multivariate predictor of all‐cause mortality (χ 2 =26.95, p <0.0001), or the secondary endpoint of all‐cause mortality or urgent transplantation (χ 2 =31.23, p <0.0001), was an NT‐proBNP concentration above the median value. Conclusion: A single measurement of NT‐proBNP in patients with advanced CHF can help identify patients at the highest risk of death, and is a better prognostic marker than Et‐1, Adm and TNF‐α.