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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

1
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
2
Department of Cardiology, Loyola University Medical Center, Maywood, Illinois.
3
Department of Medicine, University of Mississippi, Jackson, Mississippi.
4
Department of Cardiology, University of Brescia, Brescia, Italy.
5
Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
6
Hanzeplein 1, University Med Center Groningen, Groningen, The Netherlands.
7
University of Glasgow, Glasgow, United Kingdom.
8
Department of Cardiology, University of Alberta, Edmonton, Canada; Inova Heart and Vascular Institute.
9
Heart and Vascular Institute, Falls Church, Virginia.
10
Cleveland Clinic, Cleveland, Ohio.
11
University of Otago, Christchurch, New Zealand.
12
Heart and Vascular Institute, Falls Church, Virginia. Electronic address: tangw@ccf.org.

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.

KEYWORDS:

Natriuretic peptide; acute heart failure; nesiritide

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