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Eur J Heart Fail. 2009 Apr;11(4):367-77. doi: 10.1093/eurjhf/hfp003. Epub 2009 Jan 29.

The prognostic value of repeated measurement of N-terminal pro-B-type natriuretic peptide in patients with chronic heart failure due to left ventricular systolic dysfunction.

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Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK.



Decreased N-terminal pro-B-type natriuretic peptide (NT-proBNP) during treatment of chronic heart failure (CHF) is associated with improved prognosis. However, there is lack of data from community-based HF programmes. We hypothesized that plasma levels of NT-proBNP, measured after optimization of pharmacotherapy in patients with CHF, may provide independent prognostic information when compared with baseline values and conventional prognostic markers.


N-terminal pro-B-type natriuretic peptide was measured in 354 patients with CHF and left ventricular ejection fraction <45%, who had recently been enrolled in a community-based HF programme. Patients underwent a 6 min walk test and clinical, echocardiographic and laboratory examinations. Pharmacotherapy was optimized; 318 patients survived until the second examination and measurement of NT-proBNP, which was performed between the 4th and 6th month of follow-up. During a median follow-up of 38.8 months, 125 patients died. Follow-up log NT-proBNP was a better predictor of death than either baseline log NT-proBNP or change in NT-proBNP (chi(2): 46.5 vs. 30.4 and 12.5, all P < 0.001). N-terminal pro-B-type natriuretic peptide was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalizations after baseline or follow-up assessment.


The measurement of NT-proBNP after optimization of pharmacotherapy provides stronger prognostic information than either the baseline value, the change in NT-proBNP, or other conventional methods of assessment.

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