Long-term clinical variation of NT-proBNP in stable chronic heart failure patients

Abstract

Aims Here, the aim is to assess long-term clinical variation (CV) of N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable chronic heart failure (CHF) patients. The proposed use of NT-proBNP for monitoring of CHF patients will require accurate information about long-term CV of the peptide. Methods and results Medication, biochemical variables, and NYHA class were recorded at 1-year and 2-year follow-up in patients treated in our heart failure clinic. Only patients without changes in medication and the NYHA class who were not hospitalized or died in the period from first follow-up to 12 months after the second follow-up were included. A total of 78 patients fulfilled the criteria, and year-to-year CV was calculated to 30% (median) (range: 0-111%) (% changes range: 287 to 397%). Log transformation of NT-proBNP (skewed to the right) reduced the year-to-year CV to 4.7% (range: 0-22%) (% changes range: 218 to 38%). Conclusion Long-term CV of plasma concentrations of NT-proBNP in stable CHF patients is 30%, but the variation is substantial. Therefore, high long-term CV of NT-proBNP does not necessarily carry prognostic significance within the subsequent 12 months. Plasma concentrations of NT-proBNP followed a lognormal distribution, and the low CV of log(NT-proBNP) indicate that NT-proBNP levels are constant during stable conditions.

Assessing the benefits of natriuretic peptides-guided therapy in chronic heart failure

“…However, 90% of patients treated with NPs-guided care had a normal ejection function [39]. Present data seem to indicate that NPs-guides care might be less efficacious in patients with reduced ejection function and high NT-proBNP levels [42,48]. If confirmed, these findings would reduce the utility of NPs-guided care in this type of CHF.…”

“…In stable CHF increased risk is evident from a BNP level of 100 pg/mL, with each further Brunner-La Rocca H-P, Buser P, Dubach P, Erne P, Estlinbaum W, Maeder M, Pfisterer ME, Rickenbacher P, Suter T, Vuillomenet A Giuseppe Cocco, Paul Jerie, Assessing the benefits of natriuretic peptides-guided therapy in CHF 100 pg/mL increase associated with a 35% increase in risk [7,39,[43][44][45][46][47]. For NT-proBNP the risk is evident from 200 pg/mL and rises almost exponentially with increasing levels, especially above 100 pg/mL [33,44,45,48]. Table 2 shows the values for NPs which are consistently associated with cardiovascular complications in patients with CHF.…”

“…In CHF, NPs levels have been shown to fall in response to loop diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers and mineral receptor antagonists [29][30][31][32][33][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. The response to the beta-blocker metoprolol is complex, sometimes with a rise of BNP levels in the first 2-3 months followed by a fall [26].…”

Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT‐proBNP

“…BNP and NT-proBNP are released in response to myocyte stretch [13], and are elevated in asymptomatic as well as symptomatic CHF [14,15]. The concentration of the peptide hormone increases with the severity of CHF, but threshold values have not yet been defined [5,16,17]. Recently, Pitzalis et al [18] evaluated BNP as a prognostic factor in patients with CHF after CRT device implantation.…”

Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide

“…20 Even in stable hospital outpatients, the reference change value is reported as 43%. 21 However, it may be possible to reduce the within-person variability by focusing on the conditions under which the measurement is made. 20 The cut-off points for entry to the study were guided by data from the ECHOES (EChocardiographic Heart Of England Screening) study, but were essentially arbitrary and chosen to identify patients in the top quintile of risk.…”