TY - JOUR
T1 - Reduction in BNP Levels With Treatment of Decompensated Heart Failure and Future Clinical Events
AU - Dhaliwal, Amandeep S.
AU - Deswal, Anita
AU - Pritchett, Allison
AU - Aguilar, David
AU - Kar, Biswajit
AU - Souchek, Julianne
AU - Bozkurt, Biykem
N1 - Funding Information:
Dr. Bozkurt is a recipient of a Merit Entry Level grant support from Veterans Affairs Medical Research Service (MRS). Drs. Aguilar and Pritchett are recipients of Mentored Clinical Scientist Development Program (NIH- K12 Award) awards from NIH.
PY - 2009/5
Y1 - 2009/5
N2 - Background: Brain natriuretic peptide (BNP) levels correlate with outcomes in patients with heart failure (HF). We sought to compare the relationship between absolute and relative changes in BNP with future clinical events, and whether serial BNP measurements add prognostic information in patients treated for decompensated HF. Methods and Results: In 203 patients treated for HF, increasing tertiles of BNP levels after treatment had a hazard ratio of 1.4 (1.1-1.7, P < .01) and increasing tertiles of percent reduction in BNP, had a hazard ratio of 0.7 (0.6-0.9, P = .005), respectively, for the combined end point of total mortality or readmission for HF. Higher baseline BNP levels did not decrease to lower BNP levels as often as lower BNP levels (P < .001). Follow-up BNP performed better in a model, incorporating age, ejection fraction, prior HF hospitalization, New York Heart Association Class, race, use of β-blockers and renin-angiotensin axis inhibitors and renal insufficiency, than did baseline BNP or percent reduction in BNP. More BNP measurements other than the follow-up BNP did not improve the fit of the model further. Conclusions: These results suggest that both lower absolute BNP levels and greater percentage reduction in BNP with treatment of decompensated HF are associated with better event-free survival. Advocating a threshold BNP to which patients should be treated may not be possible given that high BNP levels tend not to decrease to levels associated with better outcomes during the short period of treatment. More BNP measurements do not add prognostic information beyond that provided by a single BNP level after treatment.
AB - Background: Brain natriuretic peptide (BNP) levels correlate with outcomes in patients with heart failure (HF). We sought to compare the relationship between absolute and relative changes in BNP with future clinical events, and whether serial BNP measurements add prognostic information in patients treated for decompensated HF. Methods and Results: In 203 patients treated for HF, increasing tertiles of BNP levels after treatment had a hazard ratio of 1.4 (1.1-1.7, P < .01) and increasing tertiles of percent reduction in BNP, had a hazard ratio of 0.7 (0.6-0.9, P = .005), respectively, for the combined end point of total mortality or readmission for HF. Higher baseline BNP levels did not decrease to lower BNP levels as often as lower BNP levels (P < .001). Follow-up BNP performed better in a model, incorporating age, ejection fraction, prior HF hospitalization, New York Heart Association Class, race, use of β-blockers and renin-angiotensin axis inhibitors and renal insufficiency, than did baseline BNP or percent reduction in BNP. More BNP measurements other than the follow-up BNP did not improve the fit of the model further. Conclusions: These results suggest that both lower absolute BNP levels and greater percentage reduction in BNP with treatment of decompensated HF are associated with better event-free survival. Advocating a threshold BNP to which patients should be treated may not be possible given that high BNP levels tend not to decrease to levels associated with better outcomes during the short period of treatment. More BNP measurements do not add prognostic information beyond that provided by a single BNP level after treatment.
KW - Natriuretic peptides
KW - biomarker
KW - clinical outcomes
KW - heart failure
KW - serial
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U2 - 10.1016/j.cardfail.2008.11.007
DO - 10.1016/j.cardfail.2008.11.007
M3 - Article
C2 - 19398076
AN - SCOPUS:65249094825
SN - 1071-9164
VL - 15
SP - 293
EP - 299
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 4
ER -