Lack of decrease in plasma N-terminal pro-brain natriuretic peptide identifies acute heart failure patients with very poor outcome
Received 24 March 2007; accepted 7 July 2007. published online 05 December 2007.
Abstract
Background
Optimal risk stratification in heart failure patients surviving an episode of acute decompensation has not yet been established. We investigated whether a lack of significant decrease in plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) during hospital stay can identify patients at high risk of poor outcome.
Methods
We studied 103 consecutive patients with acute heart failure (86 men, age: 64±13 years, LVEF: 28±8%). The primary end-point was all-cause mortality at 1-year follow-up.
Results
Median plasma NT-proBNP on admission was 6116 pg/mL (upper/lower quartiles: 3575, 10,958) vs. 2930 pg/mL (1674, 5794) after clinical stabilization (7±3 days after admission). During the 1-year follow-up 29 (28%) patients died. A decrease in plasma NT-proBNP during clinical recovery (expressed as percentage of NT-proBNP on admission) predicted favorable outcome in the single predictor analysis (p<0.001) and multivariable analyses (p<0.001). Receiver operating characteristic curve analysis revealed that 65% was the cut-off value for NT-proBNP decrease having best prognostic accuracy for predicting death (sensitivity 90%, specificity 37%, AUC=0.65, 95% CI: 0.54–0.74). Kaplan–Meier analysis showed that 12-month survival was 92% (95% CI: 81–100%) for patients with ≥65% NT-proBNP decrease vs 66% (95% CI: 56–76%) in those with <65% NT-proBNP decrease (p=0.02).
Conclusions
The magnitude of plasma NT-proBNP decrease in patients with acute heart failure is helpful in discrimination of patients at high risk of death. Plasma NT-proBNP level monitoring is important for risk stratification in this group of patients.
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