Combining the use of amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the prognosis of hospitalized heart failure patients.

To investigate whether the combination of measuring amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) could provide additional prognostic value in hospitalized heart failure patients. We measured both BNP and NT-proBNP simultaneously at baseline in 1464 hospitalized heart failure patients who were admitted to our heart failure center. All patients were followed-up with the median follow-up period of 533 days. The primary endpoint is a composite of all-cause death (non-transplantation patients) or heart transplantation. The median molar ratio of NT-proBNP/BNP was 2.37, but the range of the molar ratio varied from 1.57 to 3.75 (lower quartile to higher quartile). Using the cut-off value of 1790 pg/mL for NT-proBNP and 495 pg/mL for BNP from the ROC curve analysis, univariate Cox proportional regression analysis showed that the low/high group (NT-proBNP < 1790 pg/mL and BNP ≥ 495 pg/mL), high/low group (NT-proBNP ≥ 1790 pg/mL and BNP < 495 pg/mL) and high/high group (NT-proBNP ≥ 1790 pg/mL and BNP ≥ 495 pg/mL) had significant higher risk of all-cause death or heart transplantation [HR (hazard ratio): 2.87, 95% CI (confidence interval): 1.69-4.89, p < .001; HR: 2.68, 95% CI: 1.91-3.76, p < .001; HR:5.07, 95% CI: 3.85-6.67, p < .001] than low/low group (NT-proBNP < 1790 pg/mL and BNP < 495 pg/mL). In turn, the high/high group had higher risk of all-cause death or heart transplantation than low/high (HR: 1.70, 95% CI: 1.04-2.80, p = .035) and high/low groups (HR: 1.88, 95% CI: 1.42-2.49, p < .001). The low/high and high/low groups had a similar risk of all-cause death or heart transplantation. Further multivariable Cox regression analysis also showed that both BNP and NT-proBNP above the cut-off values independently predicted the worst prognosis, while either one of the two biomarkers above the cut-off value indicated the moderate poor prognosis and both below the cut-off values indicated the best prognosis (p for trend< 0.001). The plasma levels of NT-proBNP and BNP do not always increase proportionally in heart failure patients. The combination of testing NT-proBNP and BNP may add prognostic value to predict adverse events in hospitalized heart failure patients.

Wang Y ，Zhang R ，Huang Y ，Zhai M ，Zhou Q ，An T ，Huang Y ，Zhao X ，Tian P ，Zhang Y ，Zhang J ... -  《-》

The Molar Ratio of N-terminal pro-B-type Natriuretic Peptide/B-type Natriuretic Peptide for Heart Failure-related Events in Stable Outpatients with Cardiovascular Risk Factors.

Suzuki S ，Sugiyama S 《-》

Comparison of BNP and NT-proBNP in Patients With Heart Failure and Reduced Ejection Fraction.

Rørth R ，Jhund PS ，Yilmaz MB ，Kristensen SL ，Welsh P ，Desai AS ，Køber L ，Prescott MF ，Rouleau JL ，Solomon SD ，Swedberg K ，Zile MR ，Packer M ，McMurray JJV ... -  《-》

[Comparative prognostic value of plasma and urinary N-terminal pro-B-type natriuretic peptide in patients with acute destabilized heart failure].

Urinary concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP) may be prognostically meaningful; however, direct comparison to plasma concentrations of this marker have not been performed in patients with acutely decompensated heart failure (ADHF). The aims of this study were to compare the prognostic value of plasma versus urinary NT-proBNP concentration for the risk stratification of patients with ADHF. Consecutive hospitalized patients with ADHF were prospectively studied. Blood and urine samples were simultaneously collected on hospital arrival to determine NT-proBNP concentrations. Clinical follow-up was obtained, and the occurrence of mortality and heart failure hospitalization was registered. The study included 138 patients (median, 74 years [interquartile range, 67-80]; 54% men). During a median follow-up period of 387 days [interquartile range, 161-559], 65 patients (47%) suffered adverse clinical events. Plasma NT-proBNP concentration was higher among patients who presented adverse events (4561 pg/mL [2191-8631] vs 2906 pg/mL [1643-5823]; P=.03), whereas urinary NT-proBNP was similar in both groups (P=.62). After multivariable Cox regression analyses, plasma NT-proBNP concentration was associated with a higher risk of adverse events, whether considered continuously (per 100 pg/mL; hazard ratio [HR]=1.004; 95% confidence interval [CI], 1.001-1.007; P=.003) or categorically (≥3345 pg/mL; HR=2.35; 95%CI, 1.41-3.93; P=.001). In contrast, urinary NT-proBNP concentration was not associated with adverse outcomes. Plasma NT-proBNP concentration is superior to urinary NT-proBNP concentration for the prediction of adverse clinical outcomes among unselected patients with ADHF.

Manzano-Fernández S ，Januzzi JL ，Boronat García M ，Bonaque-González JC ，Muñoz-Esparza C ，Albaladejo-Otón MD ，Pastor-Pérez FJ ，Pastor P ，Valdés M ，Pascual-Figal DA ... -  《-》

Usefulness of N-terminal pro-brain natriuretic Peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failure and preserved left ventricular ejection fraction.

Grewal J ，McKelvie RS ，Persson H ，Tait P ，Carlsson J ，Swedberg K ，Ostergren J ，Lonn E ... -  《AMERICAN JOURNAL OF CARDIOLOGY》