RETROSPECTIVE LOOK AT CHANGE IN BRAIN NATRIURETIC PEPTIDE VALUES IN AMBULATORY PATIENTS WITH CHRONIC HEART FAILURE
Abstract
Background: There is significant interest in the role of B-type natriuretic peptide (BNP) guidedtherapy for outpatient congestive heart failure (CHF) patients. The objective of this study was tosee if the percentage change in BNP levels can predict CHF hospitalisations or death. Methods:We retrospectively reviewed the records of CHF patients who had BNP levels drawn on two clinicvisits. Patients were divided into two groups, those with a 70% or greater increase in the BNPvalues and those in whom the BNP value either decreased or did not increase by 70%. Primaryoutcome measured was the need for hospitalisation for CHF or death within 6 months of thesecond clinic visit. Results: One hundred and fourteen (114) paired BNP measurements wereincluded in the analysis. Of these, 26 had >70% increase in BNP while 88 did not. Hospitalisationsfor CHF or death at 6 months were significantly higher in the former group than the latter(p=0.04). On multivariate regression analysis significant change in BNP remained a predictor ofadverse outcomes. Conclusions: In stable outpatients with CHF, >70% increase in BNP is anindependent risk factor for CHF hospitalisations or death at 6 months.Keywords: Congestive heart failure, B-type natriuretic peptide, outpatient, hospitalisationReferences
Anand IS, Fisher LD, Chiang YT, Latini R, Masson S, Maggioni
AP, et al. Changes in brain natriuretic peptide and norepinephrine
over time and mortality and morbidity in the Valsartan Heart
Failure Trial (Val-HeFT). Circulation 2003;107:1278–83.
Latini R, Masson S, Wong M, Barlera S, Carretta E,
Staszewsky L, et al. Incremental prognostic value of changes in
B-type natriuretic peptide in heart failure. Am J Med
;119:70.e23–30.
Miller WL, Hartman KA, Burritt MF, Grill DE, Rodeheffer RJ,
Burnett JC Jr, Jaffe AS. Serial biomarker measurements in
ambulatory patients with chronic heart failure: the importance of
change over time. Circulation 2007;116:249–57.
Pfisterer M, Buser P, Rickli H, Gutmann M, Erne P,
Rickenbacher P, et al. BNP-guided vs symptom-guided heart
failure therapy: the Trial of Intensified vs Standard Medical
Therapy in Elderly Patients With Congestive Heart Failure
(TIME-CHF) randomized trial. JAMA 2009;301:383–92.
Wu AH. Serial testing of B-type natriuretic peptide and NTproBNP for monitoring therapy of heart failure: the role of biologic
variation in the interpretation of results. Am Heart J
;152:828–34.
deLemos JA, McGuire DK, Drazner MH. B-type natriuretic
peptide in cardiovascular disease. Lancet 2003;362:316–22.
Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander
JE, Duc P, et al. Rapid measurement of B-type natriuretic peptide
in the emergency diagnosis of heart failure. N Engl J Med
;347:161–7.
Jourdain P, Jondeau G, Funck F, Gueffet P, Le HA, Donal E, et
al. Plasma brain natriuretic peptide-guided therapy to improve
outcome in heart failure: the STARS-BNP Multicenter Study. J
Am Coll Cardiol 2007;49:1733–9.
Maeder MT, Hack D, Rickli H, Rocca HP, Riesen W, Ammann
P. Relevance of short-term variation of B-type natriuretic peptide
in patients with clinically stable heart failure. Wien Klin
Wochenschr 2008;120:672–8.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.