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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

      More than 40% of patients hospitalized with heart failure have preserved left ventricular ejection fraction (HF-PLVEF) and are at high risk for cardiovascular (CV) events. The purpose of this study was to determine the value of N-terminal pro–brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) in predicting CV outcomes in patients with HF-PLVEF. Participants with an ejection fraction >40% in the prospective CHARM Echocardiographic Substudy were included in this analysis. Plasma NT-proBNP levels were measured, and 2 cut-offs were selected prospectively at 300 pg/ml and 600 pg/ml. BNP cut-off was set at 100 pg/ml. Clinical characteristics were recorded, and systolic and diastolic function were evaluated by echocardiography. The primary substudy outcome was the composite of CV mortality, hospitalization for heart failure, and myocardial infarction or stroke. A total of 181 patients were included, and there were 17 primary CV events (9.4%) during a median follow-up time of 524 days. In a model including clinical characteristics, echocardiographic measures, and BNP or NT-proBNP, the composite CV event outcome was best predicted by NT-proBNP >300 pg/ml (hazard ratio 5.8, 95% confidence intervals [CI] 1.3 to 26.4, p = 0.02) and moderate or severe diastolic dysfunction on echocardiography. When NT-proBNP >600 pg/ml was used in the model, it was the sole independent predictor of primary CV events (hazard ratio 8.0, 95% CI 2.6 to 24.8, p = 0.0003) as was BNP >100 pg/ml (hazard ratio 3.1, 95% CI 1.2 to 8.2, p = 0.02) in the BNP model. In conclusion, both elevated NT-proBNP and BNP are strong independent predictors of clinical events in patients with HF-PLVEF.
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      References

        • Redfield M.
        • Jacobsen S.
        • Burnett J.
        • Mahoney D.
        • Bailey K.
        • Rodeheffer R.
        Burden of systolic and diastolic ventricular dysfunction in the community.
        JAMA. 2003; 289: 194-202
        • Chen A.A.
        • Wood M.J.
        • Krauser D.G.
        • Baggish A.L.
        • Tung R.
        • Anwaruddin S.
        • Picard M.H.
        • Januzzi J.L.
        NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) echocardiographic substudy.
        Eur Heart J. 2006; 27: 839-845
        • Yusuf S.
        • Pfeffer M.A.
        • Swedberg K.
        • Granger C.B.
        • Held P.
        • McMurray J.J.
        • Michelson E.L.
        • Olofsson B.
        • Ostergren J.
        • CHARM Investigators and Committees
        Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial.
        Lancet. 2003; 362: 777-781
        • Persson H.
        • Lonn E.
        • Magnus E.
        • Lawrence B.
        • Lang C.
        • Morton J.
        • Östergren J.
        • McKelvie R.
        • investigators of the CHARM Echocardiographic Sub study – CHARMES
        Diastolic dysfunction in heart failure with preserved systolic function – need for objective evidence.
        J Am Coll Cardiol. 2007; 49: 687-694
        • Oki T.
        • Tabata T.
        • Yamada H.
        Evaluation of left atrial filling using systolic pulmonary venous flow measurements in patients with atrial fibrillation.
        Clin Cardiol. 1998; 21: 169-174
        • Traversi E.
        • Cobelli F.
        • Pozzoli M.
        Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure even when atrial fibrillation is present.
        Eur J Heart Fail. 2001; 3: 173-181
        • Lang R.M.
        • Bierig M.
        • Devereaux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • et al.
        Members of the Chamber Quantification Writing Group Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Society of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Januzzi J.L.
        • Camargo C.A.
        • Anwaruddin S.
        • Baggish A.L.
        • Chen A.A.
        • Krauser D.G.
        • Tung R.
        • Cameron R.
        • Nagurney J.T.
        • Chae C.U.
        • et al.
        The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study.
        Am J Cardiol. 2005; 95: 948-954
        • Vasan R.S.
        • Benjamin E.J.
        Diastolic heart failure – no time to relax.
        New Engl J Med. 2001; 344: 56-59
        • Hosmer D.W.
        • Lemeshow S.
        Applied Logistic Regression.
        in: Wiley, New York2000: 128-134
        • Maisel A.S.
        • Krishnaswamy P.
        • Nowak R.M.
        • McCord J.
        • Hollander J.E.
        • Duc P.
        • Omland T.
        • Storrow A.B.
        • Abraham W.T.
        • Wu A.H.
        • et al.
        Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
        New Engl J Med. 2002; 347: 161-167
        • Bettencourt P.
        • Azevedo A.
        • Pimenta J.
        • Frioes F.
        • Ferreira S.
        • Ferreira A.
        N terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients.
        Circulation. 2004; 110: 2168-2174
        • Cleland J.G.F.
        • Taylor J.
        • Tendera M.
        Prognosis in heart failure and normal ejection fraction.
        New Engl J Med. 2007; 357: 829
        • Kragelund C.
        • Gronning B.
        • Kober L.
        • Hildebrandt P.
        • Steffensen R.
        N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease.
        New Engl J Med. 2005; 352: 666-675
        • Iwanaga Y.
        • Nishi I.
        • Furuichi S.
        • Noguchi T.
        • Sase K.
        • Kihara Y.
        • Goto Y.
        • Nonogi H.
        B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure.
        J Am Coll Cardiol. 2006; 47: 742-748
        • Dokainish H.
        • Zoghbi W.
        • Lakkis N.
        • Quinones M.
        • Nagueh S.
        Comparative accuracy of B-type natriuretic peptide and tissue doppler echocardiography in the diagnosis of congestive heart failure.
        Am J Cardiol. 2004; 93: 1130-1135
        • Ahluwalia A.
        • MacAllister R.J.
        • Hobbs A.J.
        Vascular actions of natriuretic peptides.
        Basic Res Cardiol. 2004; 99: 83-89
        • Kistorp C.
        • Raymond I.
        • Pedersen F.
        • Gustafsson F.
        • Faber J.
        • Hildebrandt P.
        N terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults.
        JAMA. 2005; 293: 1609-1616
        • Rudiger A.
        • Gasser S.
        • Fischler M.
        • Hornemann T.
        • Von Eckardstein A.
        • Maggiorini M.
        Comparable increase of B-type natriuretic peptide and aminoterminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure.
        Crit Care Med. 2006; 34: 2140-2144
        • Zoccali C.
        Traditional and emerging cardiovascular and renal risk factors: an epidemiologic perspective.
        Kidney Int. 2006; 70: 26-33
        • Pfister R.
        • Tan D.
        • Thekkanal J.
        • Hellmich M.
        • Erdmann E.
        • Schneider C.A.
        NT-pro-BNP measured at discharge predicts outcome in multimorbid diabetic inpatients with a broad spectrum of cardiovascular disease.
        Acta Diabetol. 2007; 44: 91-97
        • Pocock S.J.
        • Wang D.
        • Pfeffer M.
        • Yusuf S.
        • McMurray J.V.
        • Swedburg K.B.
        • Ostergren J.
        • Michelson E.L.
        • Pieper K.S.
        • Granger C.B.
        Predictors of mortality and morbidity in patients with chronic heart failure.
        Eur Heart J. 2006; 27: 65-75
        • Tsang T.S.
        • Barnes M.E.
        • Gersh B.J.
        • Bailey K.R.
        • Seward J.B.
        Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden.
        Am J Cardiol. 2002; 90: 1284-1289
        • Pritchett A.M.
        • Mahoney D.W.
        • Jacobsen S.J.
        • Rodeheffer R.J.
        • Karon B.L.
        • Redfield M.
        Diastolic dysfunction and left atrial volume: a population based study.
        J Am Coll Cardiol. 2005; 45: 87-92
        • Benjamin E.J.
        • D'Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        • Levy D.
        Left atrial size and the risk of stroke and death.
        Circulation. 1995; 92: 835-841
        • Tsutamoto T.
        • Wada A.
        • Maeda K.
        • Hisanaga T.
        • Maeda Y.
        • Fukai D.
        • Ohnishi M.
        • Sugimoto Y.
        • Kinoshita M.
        Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction.
        Circulation. 1997; 96: 509-516