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Heterogeneity of the prognostic significance of B-type natriuretic peptide levels on admission in patients hospitalized for acute heart failure syndromes

Published:February 12, 2016DOI:https://doi.org/10.1016/j.ejim.2016.01.023

      Highlights

      • We evaluated heterogeneity of the prognostic significance of BNP levels in AHFS.
      • Usefulness of BNP as a prognostic factor may be weakened in hyponatremic patients.
      • Prognostic significance of BNP seems weaker in patients with renal dysfunction.
      • High BNP levels may not be associated with higher mortality in hypertensive etiology.
      • Overall, high BNP levels were an important prognostic indicator in AHFS patients.

      Abstract

      Background

      We hypothesized that variation in baseline characteristics of patients with acute heart failure syndromes (AHFS) affects the prognostic significance of B-type natriuretic peptide (BNP) levels because of heterogeneity of this patient population. We evaluated the association of elevated BNP levels on admission with an increased risk of adverse clinical outcomes in subgroups of patients hospitalized for AHFS.

      Methods

      This study included patients from the acute decompensated heart failure syndromes (ATTEND) study, a multicenter prospective cohort of 4501 AHFS patients with BNP data on admission.

      Results

      The geometric mean BNP level was 654.9 pg/mL (95% confidence interval: 636.1–674.2), and the optimal cut-off value for all-cause death was 1157 pg/mL. All-cause mortality after admission was significantly higher in patients with high BNP levels (>1157 pg/mL) than in those with low BNP levels (≤1157 pg/mL) (median follow-up: 508 days, log-rank P < 0.001). Subgroup analyses were performed to evaluate the heterogeneity of the prognostic significance of BNP levels. The effect of high BNP levels on the risk of all-cause mortality was significantly greater in the subgroup of patients with a non-hypertensive etiology, low creatinine levels (<1.3 mg/dL), and high sodium levels (≥135 mEq/L) than in those without these factors (P = 0.024, P < 0.001, and P < 0.001 for the interaction, respectively).

      Conclusions

      The present analysis shows that underlying etiology of heart failure (i.e., hypertensive), renal function, and sodium levels should be considered for assessing the clinical significance of elevated BNP levels on admission in relation to the risk of adverse outcome after hospitalization for AHFS.

      Keywords

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      References

        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • Butler J.
        • Casey Jr., D.E.
        • Drazner M.H.
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines.
        J Am Coll Cardiol. 2013; 62: e147-e239
        • McMurray J.J.
        • Adamopoulos S.
        • Anker S.D.
        • Auricchio A.
        • Bohm M.
        • Dickstein K.
        • et al.
        ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society Of cardiology. developed in collaboration with the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2012; 33: 1787-1847
        • Erez A.
        • Klempfner R.
        • Goldenberg I.
        • Elis A.
        Short and long term survival following hospitalization with a primary versus non-primary diagnosis of acute heart failure.
        Eur J Intern Med. 2015; 26: 420-424
        • Franco J.
        • Formiga F.
        • Chivite D.
        • Manzano L.
        • Carrera M.
        • Arevalo-Lorido J.C.
        • et al.
        New onset heart failure – clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study.
        Eur J Intern Med. 2015; 26: 357-362
        • Fonarow G.C.
        • Peacock W.F.
        • Phillips C.O.
        • Givertz M.M.
        • Lopatin M.
        • Committee A.S.A.
        • et al.
        Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure.
        J Am Coll Cardiol. 2007; 49: 1943-1950
        • Aspromonte N.
        • Valle R.
        • Di Fusco S.A.
        • Santini M.
        • Feola M.
        Prognostic value of B-type natriuretic peptide in patients with left bundle-branch block admitted for acute heart failure.
        Eur J Intern Med. 2011; 22: e152-e154
        • Villanueva M.P.
        • Mollar A.
        • Palau P.
        • Carratala A.
        • Nunez E.
        • Santas E.
        • et al.
        Procalcitonin and long-term prognosis after an admission for acute heart failure.
        Eur J Intern Med. 2015; 26: 42-48
        • Levin E.R.
        • Gardner D.G.
        • Samson W.K.
        Natriuretic peptides.
        N Engl J Med. 1998; 339: 321-328
        • de Lemos J.A.
        • McGuire D.K.
        • Drazner M.H.
        B-type natriuretic peptide in cardiovascular disease.
        Lancet. 2003; 362: 316-322
        • Yasue H.
        • Yoshimura M.
        • Sumida H.
        • Kikuta K.
        • Kugiyama K.
        • Jougasaki M.
        • et al.
        Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure.
        Circulation. 1994; 90: 195-203
        • Hama N.
        • Itoh H.
        • Shirakami G.
        • Nakagawa O.
        • Suga S.
        • Ogawa Y.
        • et al.
        Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction.
        Circulation. 1995; 92: 1558-1564
        • de Lemos J.A.
        • Morrow D.A.
        • Bentley J.H.
        • Omland T.
        • Sabatine M.S.
        • McCabe C.H.
        • et al.
        The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes.
        N Engl J Med. 2001; 345: 1014-1021
        • Maisel A.S.
        • Krishnaswamy P.
        • Nowak R.M.
        • McCord J.
        • Hollander J.E.
        • Duc P.
        • et al.
        Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
        N Engl J Med. 2002; 347: 161-167
        • Mueller C.
        • Scholer A.
        • Laule-Kilian K.
        • Martina B.
        • Schindler C.
        • Buser P.
        • et al.
        Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea.
        N Engl J Med. 2004; 350: 647-654
        • van Veldhuisen D.J.
        • Linssen G.C.
        • Jaarsma T.
        • van Gilst W.H.
        • Hoes A.W.
        • Tijssen J.G.
        • et al.
        B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction.
        J Am Coll Cardiol. 2013; 61: 1498-1506
        • Troughton R.W.
        • Frampton C.M.
        • Brunner-La Rocca H.P.
        • Pfisterer M.
        • Eurlings L.W.
        • Erntell H.
        • et al.
        Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis.
        Eur Heart J. 2014; 35: 1559-1567
        • Maisel A.
        • Mueller C.
        • Adams Jr., K.
        • Anker S.D.
        • Aspromonte N.
        • Cleland J.G.
        • et al.
        State of the art: using natriuretic peptide levels in clinical practice.
        Eur J Heart Fail. 2008; 10: 824-839
        • Ambrosy A.P.
        • Fonarow G.C.
        • Butler J.
        • Chioncel O.
        • Greene S.J.
        • Vaduganathan M.
        • et al.
        The global health and economic burden of hospitalizations for heart failure: Lessons learned from hospitalized heart failure registries.
        J Am Coll Cardiol. 2014; 63: 1123-1133
        • Sato N.
        • Kajimoto K.
        • Asai K.
        • Mizuno M.
        • Minami Y.
        • Nagashima M.
        • et al.
        Acute decompensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: rationale, design, and preliminary data.
        Am Heart J. 2010; 159 ([e1]): 949-955
        • MJ Radford
        • JM Arnold
        • SJ Bennett
        • MP Cinquegrani
        • JG Cleland
        • EP Havranek
        • et al.
        ACC/AHA key data elements and definitions for measuring the clinical management and outcomes of patients with chronic heart failure: A report of the American College of Cardiology/American Heart Association task force on clinical data standards (writing committee to develop heart failure clinical data standards): Developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Failure Society of America..
        Circulation. 2005; 112: 1888-1916
        • Kazory A.
        • Ross E.A.
        Anemia: The point of convergence or divergence for kidney disease and heart failure?.
        J Am Coll Cardiol. 2009; 53: 639-647
        • Lakatos E.
        Sample sizes based on the log-rank statistic in complex clinical trials.
        Biometrics. 1988; 44: 229-241
        • Vasan R.S.
        • Benjamin E.J.
        • Larson M.G.
        • Leip E.P.
        • Wang T.J.
        • Wilson P.W.
        • et al.
        Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: The Framingham heart study.
        JAMA. 2002; 288: 1252-1259
        • Farmakis D.
        • Filippatos G.
        • Parissis J.
        • Kremastinos D.T.
        • Gheorghiade M.
        Hyponatremia in heart failure.
        Heart Fail Rev. 2009; 14: 59-63
        • Verbrugge F.H.
        • Steels P.
        • Grieten L.
        • Nijst P.
        • Tang W.H.
        • Mullens W.
        Hyponatremia in acute decompensated heart failure: depletion versus dilution.
        J Am Coll Cardiol. 2015; 65: 480-492
        • deFilippi C.R.
        • Seliger S.L.
        • Maynard S.
        • Christenson R.H.
        Impact of renal disease on natriuretic peptide testing for diagnosing decompensated heart failure and predicting mortality.
        Clin Chem. 2007; 53: 1511-1519
        • Forfia P.R.
        • Watkins S.P.
        • Rame J.E.
        • Stewart K.J.
        • Shapiro E.P.
        Relationship between B-type natriuretic peptides and pulmonary capillary wedge pressure in the intensive care unit.
        J Am Coll Cardiol. 2005; 45: 1667-1671
        • Bistola V.
        • Parissis J.T.
        • Paraskevaidis I.
        • Panou F.
        • Nikolaou M.
        • Ikonomidis I.
        • et al.
        Prognostic value of tissue Doppler right ventricular systolic and diastolic function indexes combined with plasma B-type natriuretic peptide in patients with advanced heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
        Am J Cardiol. 2010; 105: 249-254
        • Clavel M.A.
        • Malouf J.
        • Michelena H.I.
        • Suri R.M.
        • Jaffe A.S.
        • Mahoney D.W.
        • et al.
        B-type natriuretic peptide clinical activation in aortic stenosis: Impact on long-term survival.
        J Am Coll Cardiol. 2014; 63: 2016-2025
        • Fujimoto N.
        • Onishi K.
        • Sato A.
        • Terasaki F.
        • Tsukada B.
        • Nozato T.
        • et al.
        Incremental prognostic values of serum tenascin-C levels with blood B-type natriuretic peptide testing at discharge in patients with dilated cardiomyopathy and decompensated heart failure.
        J Card Fail. 2009; 15: 898-905
        • Drazner M.H.
        The progression of hypertensive heart disease.
        Circulation. 2011; 123: 327-334
        • Cataliotti A.
        • Tonne J.M.
        • Bellavia D.
        • Martin F.L.
        • Oehler E.A.
        • Harders G.E.
        • et al.
        Long-term cardiac pro-B-type natriuretic peptide gene delivery prevents the development of hypertensive heart disease in spontaneously hypertensive rats.
        Circulation. 2011; 123: 1297-1305
        • Tonne J.M.
        • Holditch S.J.
        • Oehler E.A.
        • Schreiber C.A.
        • Ikeda Y.
        • Cataliotti A.
        Cardiac BNP gene delivery prolongs survival in aged spontaneously hypertensive rats with overt hypertensive heart disease.
        Aging. 2014; 6: 311-319
        • Kajimoto K.
        • Sato N.
        • Keida T.
        • Mizuno M.
        • Sakata Y.
        • Asai K.
        • et al.
        Association between length of stay, frequency of in-hospital death, and causes of death in Japanese patients with acute heart failure syndromes.
        Int J Cardiol. 2013; 168: 554-556