Prognostic Implications of Changes in Amino-Terminal Pro-B-Type Natriuretic Peptide in Acute Decompensated Heart Failure: Insights From ASCEND-HF.

Abstract

BACKGROUND:

Amino-terminal pro-B-type natriuretic peptide (NTproBNP) is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification.

METHODS:

Baseline, 48-72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF.

RESULTS:

The median NTproBNP at baseline was 5773 (2981-11,579) pg/mL; at 48-72 hours was 3036 (1191-6479) pg/mL; and at 30 days was 2914 (1364-6667) pg/mL. Absolute changes in NTproBNP by 48-72 hours were not associated with 30-day heart failure rehospitalization or mortality (P = .065), relative changes in NTproBNP were nominally associated (P = .046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48-72 hours and to 30 days were closely associated with 180-day mortality (P < .02 for all) with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points).

CONCLUSIONS:

Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.

• Authors: Justin L Grodin, Max J Liebo, Javed Butler, Marco Metra, G Michael Felker, Adrian F Hernandez, Adriaan A Voors, John J McMurray, Paul W Armstrong, Christopher O'Connor, Randall C Starling, Richard W Troughton, W H Wilson Tang
• Journal: Journal of cardiac failure (J Card Fail) Vol. 25 Issue 9 Pg. 703-711 (Sep 2019) ISSN: 1532-8414 [Electronic] United States
• PMID: 30953792 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Natriuretic Agents
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Acute Disease
• Aged
• Biomarkers (blood)
• Double-Blind Method
• Female
• Follow-Up Studies
• Heart Failure (blood, drug therapy, physiopathology)
• Humans
• Male
• Middle Aged
• Natriuretic Agents (administration & dosage, adverse effects)
• Natriuretic Peptide, Brain (administration & dosage, adverse effects, blood)
• Outcome Assessment, Health Care (methods)
• Peptide Fragments (blood)
• Prognosis
• Time Factors
• Treatment Outcome