The Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide for Death and Cardiovascular Events in Healthy Normal and Stage A/B Heart Failure Subjects

Abstract

Objectives Our objective was to determine the prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) for death and cardiovascular events among subjects without risk factors for heart failure (HF), which we term healthy normal. Background Previous studies report that plasma NT-proBNP has prognostic value for cardiovascular events in the general population even in the absence of HF. It is unclear if NT-proBNP retains predictive value in healthy normal subjects. Methods We identified a community-based cohort of 2,042 subjects in Olmsted County, Minnesota. Subjects with symptomatic (stage C/D) HF were excluded. The remaining 1,991 subjects underwent echocardiography and NT-proBNP measurement. We further defined healthy normal (n = 703) and stage A/B HF (n = 1,288) subgroups. Healthy normal was defined as the absence of traditional clinical cardiovascular risk factors and echocardiographic structural cardiac abnormalities. Subjects were followed for death, HF, cerebrovascular accident, and myocardial infarction with median follow-up of 9.1, 8.7, 8.8, and 8.9 years, respectively. Results NT-proBNP was not predictive of death or cardiovascular events in the healthy normal subgroup. Similar to previous reports, in stage A/B HF, plasma NT-proBNP values greater than age-/sex-specific 80th percentiles were associated with increased risk of death, HF, cerebrovascular accident, and myocardial infarction (p < 0.001 for all) even after adjustment for clinical risk factors and structural cardiac abnormalities. Conclusions These findings do not support the use of NT-proBNP as a cardiovascular biomarker in healthy normal subjects and have important implications for NT-proBNP–based strategies for early detection and primary prevention of cardiovascular disease.

Usefulness of N-Terminal Pro-Brain Natriuretic Peptide to Predict Mortality in Adults With Congenital Heart Disease

“…7,15 The difference might be explained by the fact that our cohort M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 8 comprised also patients with Eisenmenger syndrome and our whole group was significantly more symptomatic (19 % in NYHA class III-IV) compared to Eindhoven´s group with only 1% of patients in NYHA class III. 15 A smaller study with 49 symptomatic patients with CHD showed that both BNP and ANP have strong predictive value for the mortality in symptomatic ambulatory patients during long-term follow-up.…”

“…[1][2][3][4][5][6][7][8] Patients with low level of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) have excellent prognosis irrespective of echocardiographic findings. 2,9 For patients with advanced chronic heart failure natriuretic peptides have been accepted as a gold standard in predicting mortality.…”

Prognostic value of increased carbohydrate antigen in patients with heart failure

“…Thus, in advanced HF, there is controversy whether BNP concentration helps identify patients requiring heart transplantation [42,43] . Similarly, in asymptomatic individuals with HF and those in pre-HF stages, NT-proBNP failed to predict the patients who presented with clinical HF during follow-up [44] . Other limitations to the use of natriuretic peptides exist, particularly with NT-proBNP since cut-off points for assessing prognosis have not been clearly established.…”

Defining High-Sensitivity Cardiac Troponin Concentrations in the Community

“…The design and selection criteria of this community-based cohort study as well as the characteristics of the Olmsted County population have been previously described (20,21 ). We obtained baseline samples for hscTnI in 1843 individuals (199 of the 2042 individuals did not have samples to run for hs-cTnI), and only data from these individuals are included in this analysis.…”