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The prognostic value of repeated measurement of N‐terminal pro‐B‐type natriuretic peptide in patients with chronic heart failure due to left ventricular systolic dysfunction
Author(s) -
Kubánek Miloš,
Goode Kevin M.,
Lánská Věra,
Clark Andrew L.,
Cleland John G.F.
Publication year - 2009
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 - 10.1093/eurjhf/hfp003
Subject(s) - medicine , natriuretic peptide , heart failure , ejection fraction , cardiology , pharmacotherapy
Aims Decreased N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) during treatment of chronic heart failure (CHF) is associated with improved prognosis. However, there is lack of data from community‐based HF programmes. We hypothesized that plasma levels of NT‐proBNP, measured after optimization of pharmacotherapy in patients with CHF, may provide independent prognostic information when compared with baseline values and conventional prognostic markers. Methods and results N‐terminal pro‐B‐type natriuretic peptide was measured in 354 patients with CHF and left ventricular ejection fraction <45%, who had recently been enrolled in a community‐based HF programme. Patients underwent a 6 min walk test and clinical, echocardiographic and laboratory examinations. Pharmacotherapy was optimized; 318 patients survived until the second examination and measurement of NT‐proBNP, which was performed between the 4th and 6th month of follow‐up. During a median follow‐up of 38.8 months, 125 patients died. Follow‐up log NT‐proBNP was a better predictor of death than either baseline log NT‐proBNP or change in NT‐proBNP ( χ 2 : 46.5 vs. 30.4 and 12.5, all P < 0.001). N‐terminal pro‐B‐type natriuretic peptide was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalizations after baseline or follow‐up assessment. Conclusion The measurement of NT‐proBNP after optimization of pharmacotherapy provides stronger prognostic information than either the baseline value, the change in NT‐proBNP, or other conventional methods of assessment.