Title:[Admission and predischarge levels of NT pre brain natriuretic peptide in patients hospitalized because of worsening heart failure. relation to risk of death in the next 6-12 months].
Authors:Mazovets OL; Trifonov IR; Katrukha AG; Gratsianskii NA
Publication:Kardiologiia. 2009;49(1):34-8.
UNLABELLED: Inhospital treatment of patients with heart failure (HF) can cause changes of N-terminal pro-brain natriuretic peptide (NT proBNP) levels. It has not been established yet which NT proBNP value (before or at height of treatment activation) is closer related to prognosis of unfavorable outcome after discharge. AIM: To compare relation to risk of post discharge unfavorable outcome of patients with HF of NT proBNP levels measured close to hospital admission and discharge. MATERIAL AND METHODS: We studied 69 patients (64% men) aged 66.6 +/- 11.0 years with coronary heart disease or hypertension hospitalized because of worsening HF. Median left ventricular ejection fraction was 28%. NT-proBNP was measured during first 3 days of hospitalization (admission level) and in 2 weeks after first measurement (predischarge level). Duration of follow-up was 6-12 (mean 11.6 +/- 1.3) months. RESULTS: Admission NT-proBNP level (median 13.23, interquartile range 5.95-25.89 ng/ml) exceeded upper limit of normal (ULN) in 67 patients (97.1%). Predischarge NT-proBNP became significantly lower (median 6.02 ng/ml, interquartile range 2.52-12.23 ng/ml; p=0.012), but remained above ULN in 62 patients (89.8%). During follow-up 27 patients (39.1%) died. Median NT-proBNP in the group of patients who later died compared with those who survived was insignificantly higher at admission (15.03 vs. 9.9 ng/ml, respectively, p=0.09) and significantly higher at predischarge (8.65 vs. 3.60 ng/ml, respectively, p=0.012). Analysis of receiver operating characteristic curves identified predischarge NT-proBNP level 3.5 ng/ml as cut - off value for increased risk of death. Multivariate regression analysis selected predischarge NT-proBNP more or equal 3.5 ng/ml as independent predictor of death during follow-up. CONCLUSION: In this group of patients hospitalized because of worsening HF predischarge but not admission NT-proBNP level was independently related to risk of death during next 6-12 months.