scispace - formally typeset
Search or ask a question
Journal ArticleDOI

N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients

12 Oct 2004-Circulation (Lippincott Williams & Wilkins)-Vol. 110, Iss: 15, pp 2168-2174
TL;DR: Variations in NT-proBNP levels are related to hospital readmission and death within 6 months and are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients.
Abstract: Background— Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal–pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients. Methods and Results— We included 182 patients consecutively admitted to hospital because of decompensated HF. Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL (P<0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (n=82), (2) no significant modifications on NT-proBNP levels (n=49), and (3) increasing NT-proBNP levels by at least 30% (n=25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rat...
Citations
More filters
Journal ArticleDOI
TL;DR: The next generation of leaders in the field of FACC/FAHA education and training will be shaped by the experiences of the past 50 years, which will help shape the future of the profession.

3,041 citations


Cites background from "N-Terminal–Pro-Brain Natriuretic Pe..."

  • ...2004 (29) 15451800 Aim: To compare 18 mo outcomes of NT-BNPguided vs....

    [...]

Journal ArticleDOI
TL;DR: The medical profession should play a central role in evaluating the evidence related to drugs, according to a report by the World Health Organization and the European Medicines Agency.
Abstract: The medical profession should play a central role in evaluating the evidence related to drugs, …

2,859 citations


Cites background from "N-Terminal–Pro-Brain Natriuretic Pe..."

  • ...BNP and NT-proBNP levels improve with treatment of chronic HF, with lowering of levels over time in general, correlating with improved clinical outcomes.(248,251,254,260) Thus, BNP or NT-proBNP “guided” therapy has been studied against standard care without natriuretic peptide measurement to determine whether guided therapy renders superior achievement of GDMT in patients with HF....

    [...]

Journal ArticleDOI
TL;DR: Biykem Bozkurt, MD, PHD, FACC, FAHA*y Javed Butler,MD, MBA, MPH, F ACC,FAHA*z Donald E. Casey, JR, MD; Monica M.Casey, JR; and Cheryl Westlake,PHD, RN, ACNS-BC, FAha, FHFSA.

1,468 citations

Journal ArticleDOI
TL;DR: In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT- ProBNP in dysPNoeic patients.
Abstract: Aims Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents. Methods and results Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P 75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2–8.1, P <0.001]. Conclusion In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.

998 citations

References
More filters
Journal ArticleDOI
TL;DR: Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.
Abstract: Background B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension. Methods We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay. Results The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff ...

3,130 citations

Journal ArticleDOI
TL;DR: N-BNP-guided treatment of heart failure reduced total cardiovascular events, delayed time to first event compared with intensive clinically guided treatment, and changed left-ventricular function, quality of life, renal function, and adverse events were similar in both groups.

1,402 citations

Journal ArticleDOI
TL;DR: A single measurement of B-type natriuretic peptide, obtained in the first few days after the onset of ischemic symptoms, provides powerful information for use in risk stratification across the spectrum of acute coronary syndromes, and suggests that cardiac neurohormonal activation may be a unifying feature among patients at high risk for death after acute coronary syndrome.
Abstract: Background Brain (B-type) natriuretic peptide is a neurohormone synthesized predominantly in ventricular myocardium. Although the circulating level of this neurohormone has been shown to provide independent prognostic information in patients with transmural myocardial infarction, few data are available for patients with acute coronary syndromes in the absence of ST-segment elevation. Methods We measured B-type natriuretic peptide in plasma specimens obtained a mean (±SD) of 40±20 hours after the onset of ischemic symptoms in 2525 patients from the Orbofiban in Patients with Unstable Coronary Syndromes–Thrombolysis in Myocardial Infarction 16 study. Results The base-line level of B-type natriuretic peptide was correlated with the risk of death, heart failure, and myocardial infarction at 30 days and 10 months. The unadjusted rate of death increased in a stepwise fashion among patients in increasing quartiles of base-line B-type natriuretic peptide levels (P<0.001). This association remained significant in ...

1,305 citations

Journal ArticleDOI
TL;DR: It is indicated that plasma BNP is more useful than ANP for assessing the mortality in patients with chronic CHF and that the plasma levels of BNP provide prognostic information independent of other variables previously associated with a poor prognosis.
Abstract: Background Patients with congestive heart failure (CHF) have high plasma levels of atrial natriuretic peptide (ANP), mainly from the atrium, and brain natriuretic peptide (BNP), mainly from the ventricle. We examined the prognostic role of plasma BNP in chronic CHF patients in comparison with plasma ANP and other variables previously known to be associated with high mortality. We also evaluated the relationship between mortality and plasma cGMP, a biological marker of ANP and BNP. Methods and Results The study subjects were 85 patients with chronic CHF (left ventricular ejection fraction <0.45) who were followed for 2 years. The plasma levels of ANP, BNP, cGMP, and norepinephrine increased with the severity of CHF. Among plasma levels of ANP, BNP, cGMP, and norepinephrine and clinical and hemodynamic parameters, only high levels of plasma BNP (P<.0001) and pulmonary capillary wedge pressure (P=.003) were significant independent predictors of the mortality in patients with CHF by Cox proportional hazard an...

997 citations

Related Papers (5)