Send to

Choose Destination
J Card Fail. 2019 Apr 4. pii: S1071-9164(18)30979-5. doi: 10.1016/j.cardfail.2019.04.002. [Epub ahead of print]

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

Author information

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Cardiology, Loyola University Medical Center, Maywood, Illinois.
Department of Medicine, University of Mississippi, Jackson, Mississippi.
Department of Cardiology, University of Brescia, Brescia, Italy.
Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
Hanzeplein 1, University Med Center Groningen, Groningen, The Netherlands.
University of Glasgow, Glasgow, United Kingdom.
Department of Cardiology, University of Alberta, Edmonton, Canada; Inova Heart and Vascular Institute.
Heart and Vascular Institute, Falls Church, Virginia.
Cleveland Clinic, Cleveland, Ohio.
University of Otago, Christchurch, New Zealand.
Heart and Vascular Institute, Falls Church, Virginia. Electronic address:



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.


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.


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).


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.


Natriuretic peptide; acute heart failure; nesiritide

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center