NT‐proBNP in severe chronic heart failure: rationale, design and preliminary results of the COPERNICUS NT‐proBNP substudy

Hartmann, Franz; Packer, Milton; Coats, Andrew J.S.; Fowler, Michael B.; Krum, Henry; Mohaçsi, Paul; Rouleau, Jean L.; Tendera, Michał; Castaigne, A; Trawinski, Jürgen; Amann-Zalán, Ildikó; Hoersch, Silke; Katus, Hugo A.

doi:10.1016/j.ejheart.2004.01.009

Cited by 86 publications

(54 citation statements)

References 35 publications

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“…Several studies have shown the prognostic value of (NT-pro)BNP in various patient subpopulations (31)(32)(33)(34). Although we investigated unselected ER patients with a broad range of cardiac and noncardiac diagnoses, we were able to show prognostic impact with respect to hard endpoints (Fig.…”

Section: Discussionmentioning

confidence: 81%

Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room

Möckel¹,

Müller

Vollert³

et al. 2005

Clinical Chemistry

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Section: Discussionmentioning

confidence: 81%

Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room

Möckel¹,

Müller

Vollert³

et al. 2005

Clinical Chemistry

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“…In 815 patients in the Carvedilol (Coreg) Prospective Randomized Cumulative Survival (COPERNICUS) study, NTproBNP fell at 13 and 26 weeks but did not differ from placebo. 49 These patients were recently in NYHA class IV HF. Their treatment included recent increments in ACE inhibitor, angiotensin receptor blockade, and/or loop diuretic dose shortly before randomization to carvedilol or placebo.…”

Section: Discussionmentioning

confidence: 99%

Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure

et al. 2006

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Background-The effect of ␤-blockade on the cardiac natriuretic peptides is poorly understood but could contribute to their beneficial treatment effect and may be relevant to clinical use of plasma brain natriuretic peptide (BNP)/N-terminal pro brain natriuretic peptide (NTproBNP) measurements in risk stratification and in titration of anti-heart failure therapy. Methods and Results-Sixteen men with mild, stable heart failure (NYHA class II to III; left ventricular ejection fraction Ͻ40%) underwent serial blood sampling for plasma natriuretic peptide levels and received infusions of atrial natriuretic peptide (ANP) and BNP before and 6 weeks after the introduction and uptitration of metoprolol or 6 weeks unchanged therapy in a randomized, parallel-group design. Plasma natriuretic peptides (BNP, NTproBNP, ANP, and NTproANP) were increased by metoprolol (PϽ0.01 for all). The natriuretic responses to ANP and BNP infusions were sustained with the introduction of metoprolol despite reduced renal perfusion pressure. The levels of the noninfused natriuretic peptide were increased by both ANP and BNP infusions, and this effect was enhanced by metoprolol. The early plasma half-life (t 1 ⁄2␣) of BNP was prolonged by metoprolol (5.6Ϯ0.45 to 11Ϯ1.3 versus 5.7Ϯ0.8 to 6.6Ϯ1.3 minutes in control subjects; Pϭ0.019). Conclusions-Plasma cardiac natriuretic peptide levels increase significantly with the introduction of metoprolol in heart failure as a result of effects on secretion and clearance. Natriuretic responses to NP infusions are sustained with ␤-blockade despite reduced renal perfusion pressure. Clinicians should be aware that the introduction of metoprolol causes a rise in plasma BNP/NTproBNP that is unrelated to deterioration in clinical status and must be considered when measurements are undertaken for risk stratification or titration of treatment.

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“…All other patients were excluded. Hence, the effects of changes in heart failure medication on plasma concentrations of NT-proBNP were avoided, [14][15][16][17][18][19] and changes in plasma concentrations of NT-proBNP could be considered without prognostic significance within the subsequent 12 months.…”

Section: Protocolmentioning

confidence: 99%

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

Schou¹,

Gustafsson²,

Kjær³

et al. 2006

European Heart Journal

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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.

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NT‐proBNP in severe chronic heart failure: rationale, design and preliminary results of the COPERNICUS NT‐proBNP substudy

Cited by 86 publications

References 35 publications

Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room

Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room

Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure

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

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