The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure

Lee, Shang Chiun; Stevens, Tracy L.; Sandberg, Sharon M.; Heublein, Denise M.; Nelson, Sarah; Jougasaki, Michihisa; Redfield, Margaret M.; Burnett, John C.

doi:10.1054/jcaf.2002.125368

Cited by 125 publications

(64 citation statements)

References 11 publications

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“…30 Patients with clinical improvement during a 6-to 12-month follow-up have a 45% decrease in BNP levels. 31 We arbitrarily defined 30% variation of NT-proBNP levels as the threshold for meaningful variation because length of hospital stay was much shorter than time between ambulatory visits and because the biological variability is lower in NT-proBNP determination than in BNP. 32 Moreover, in a previous small study, patients with the worst prognosis had a 15% decrease in NT-proBNP levels, whereas patients who did not suffer the adverse outcome had a decrease Ͼ30%.…”

Section: Discussionmentioning

confidence: 99%

N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients

et al. 2004

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Background-Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients. Methods and Results-We included 182 patients consecutively admitted to hospital because of decompensated HF.Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL (PϽ0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (nϭ82), (2) no significant modifications on NT-proBNP levels (nϭ49), and (3) increasing NT-proBNP levels by at least 30% (nϭ25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rate, signs of volume overload, no use of ACE inhibitors, higher NYHA class at discharge, admission and discharge NT-proBNP, and the change in NT-proBNP levels. The variation in NT-proBNP was the strongest predictor of an adverse outcome. Independent variables associated with an increased risk of readmission or death were signs of volume overload and the change in NT-proBNP levels. Conclusions-Variations in NT-proBNP levels are related to hospital readmission and death within 6 months. NT-proBNP levels are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients. Whether therapeutic strategies aimed to lower NT-proBNP levels modify prognosis warrants future investigation.

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Section: Discussionmentioning

confidence: 99%

N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients

et al. 2004

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“…Although subject to large interindividual differences in response, previously conducted small studies indicated that BNP-or NT-proBNP-guided treatment might be superior to treatment based on clinical judgments (13,17 ). Moreover, BNP was related to the clinical picture during treatment, which implies that BNP concentrations decreased in those who responded to treatment, whereas those who did not respond had unchanged or increasing BNP concentrations (14 ). As a consequence of Clinical Chemistry 50, No.…”

Section: Discussionmentioning

confidence: 99%

High Intraindividual Variation of B-Type Natriuretic Peptide (BNP) and Amino-Terminal proBNP in Patients with Stable Chronic Heart Failure

Bruins

Fokkema

Römer³

et al. 2004

Clinical Chemistry

199

151

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Methods:We recruited 43 patients with stable chronic heart failure living in Curaçao (22 males, 21 females; median age, 63 years; range, 20 -86 years; New York Heart Association classes I-III). Samples were collected for within-day CV i (n ‫؍‬ 6; every 2 h starting at 0800), day-to-day CV i (n ‫؍‬ 5; samples collected between 0800 and 1000 on 5 consecutive days), and week-to-week CV i (n ‫؍‬ 6; samples collected between 0800 and 1000 on the same day of the week for 6 consecutive weeks). NT-proBNP (Roche) and BNP (Abbott) were measured by immunoassay. Results: Median (range) concentrations were 134 (0 -1630) ng/L (BNP) and 570 (17-5048) ng/L (NT-proBNP). Analytical variation, week-to-week CV i , and reference change values were 8.4%, 40%, and 113% (BNP), and 3.0%, 35%, and 98% (NT-proBNP). Week-to week CV i s were inversely related to median BNP concentrations. Week-to week CV i s for BNP were 44% (BNP <350 ng/L)

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“…Recently, brain natriuretic peptide (BNP) and the aminoterminal portion of the high molecular weight precursor of BNP, N-terminal pro brain natriuretic peptide (NT-proBNP), have been established as new diagnostic and prognostic markers of CHF. Plasma levels of BNP and NT-proBNP reflect the severity of CHF [5] and may thereby help to detect early deterioration of CHF [6]. However, the need for blood sampling means that these markers are not particularly suited for outpatient and/or home monitoring of CHF status.…”

Section: Introductionmentioning

confidence: 99%

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

Lüthje

Vollmann

Drescher

et al. 2007

European J of Heart Fail

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Background: An alert algorithm, based on intrathoracic impedance monitoring, has been incorporated into a cardiac resynchronisation device (CRT) to detect pulmonary fluid accumulation, and to audibly alert patients to decompensating chronic heart failure (CHF). Aims: To evaluate this algorithm, alert events were correlated with changes in NT-proBNP concentration and CHF status. Methods and results: In a prospective observational study of 62 patients (89% male, aged 67 ± 1 year), NT-proBNP plasma concentrations, clinical CHF status, and device data were collected at enrolment, during regular follow-up and at device alerts. Over a mean follow-up of 27 ± 2 weeks, pooled data indicated a weak, but significant inverse relationship between relative changes in intrathoracic impedance and NT-proBNP (r = −0.3; p b 0.001). In 52 device alerts from 35 patients, NT-proBNP increased by 66 ± 19% from 2039 ± 331 pg/ml (p b 0.001). The increase in NT-proBNP was higher in alerts with clinical signs of CHF deterioration (n = 30, 89 ± 25%; p b 0.001) than in alert events without clinical signs (n = 22, 25 ± 15%; p =n.s.). Conclusion: Intrathoracic impedance based alert events are associated with a significant increase in NT-proBNP concentration. These data indicate that intrathoracic impedance monitoring might facilitate the outpatient management of CHF patients with implanted CRT devices.

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The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure

Cited by 125 publications

References 11 publications

N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients

N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients

High Intraindividual Variation of B-Type Natriuretic Peptide (BNP) and Amino-Terminal proBNP in Patients with Stable Chronic Heart Failure

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

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