B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure

York, Michelle K.; Gupta, Deepak K.; Reynolds, Cassandra F.; Farber‐Eger, Eric; Wells, Quinn S.; Bachmann, K; Xu, Meng; Harrell, Frank E.; Wang, Thomas J.

doi:10.1016/j.jacc.2018.02.071

Cited by 117 publications

(97 citation statements)

References 35 publications

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“…This indication is supported by several diagnostic and randomised controlled studies and is consistently recommended in clinical practice guidelines . NPs also can help in a broad range of other indications, including prognostication of patients with established cardiovascular disorders such as myocardial infarction, valvular heart disease, HF and pulmonary embolism . Overall, BNP and NT‐proBNP have comparable diagnostic and prognostic accuracy; other NPs such as atrial natriuretic peptide (ANP) [or midregional proANP (MR‐proANP)] are also comparable, but less well documented.…”

Section: Introductionmentioning

confidence: 99%

Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

Müeller

McDonald

Boer

et al. 2019

European J of Heart Fail

564

473

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Natriuretic peptide [NP; B-type NP (BNP), N-terminal proBNP (NT-proBNP), and midregional proANP (MR-proANP)] concentrations are quantitative plasma biomarkers for the presence and severity of haemodynamic cardiac stress and heart failure (HF). End-diastolic wall stress, intracardiac filling pressures, and intracardiac volumes seem to be the dominant triggers. This paper details the most important indications for NPs and highlights 11 key principles underlying their clinical use shown below.(i) NPs should always be used in conjunction with all other clinical information.(ii) NPs are reasonable surrogates for intracardiac volumes and filling pressures. (iii) NPs should be measured in all patients presenting with symptoms suggestive of HF such as dyspnoea and/or fatigue, as their use facilitates the early diagnosis and risk stratification of HF. (iv) NPs have very high diagnostic accuracy in discriminating HF from other causes of dyspnoea: the higher the NP, the higher the likelihood that dyspnoea is caused by HF. (v) Optimal NP cut-off concentrations for the diagnosis of acute HF (very high filling pressures) in patients presenting to the emergency department with acute dyspnoea are higher compared with those used in the diagnosis of chronic HF in patients with dyspnoea on exertion (mild increase in filling pressures at rest). (vi) Obese patients have lower NP concentrations, mandating the use of lower cut-off concentrations (about 50% lower). (vii) In stable HF patients, but also in patients with other cardiac disorders such as myocardial infarction, valvular heart disease, atrial fibrillation or pulmonary embolism, NP concentrations have high prognostic accuracy for death and HF hospitalization.

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Section: Introductionmentioning

confidence: 99%

Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

Müeller

McDonald

Boer

et al. 2019

European J of Heart Fail

564

473

View full text Add to dashboard Cite

show abstract

“…Our unique dataset allow us to clarify clearly in a well characterised cohort of patients that a raised NT-pro-BNP is a marker of adverse prognosis even in people without LVSD as previously described. [14] Our data highlight that despite contemporary medical therapy coordinated by a secondary care clinic with a high rate of optimal doses, [48] the prognosis for consecutive, unselected elderly patients with HFrEF remains poor.…”

Section: Prognostic Utility Of a Raised Npmentioning

confidence: 84%

“…Elevated B-type natriuretic peptide (BNP) concentrations are associated with an adverse prognosis in the general population, [7] [8] and in people with [9][10] [11] and without [12][13] [14] LVSD and in heart failure, a reduction in NP concentrations with treatment is associated with an improvement in prognosis. [15] A series of screening studies in higher risk people have demonstrated that those with elevated BNP levels have a higher rate of LVSD.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation and long-term follow-up of patients referred to secondary care based upon natriuretic peptide levels in primary care

Gierula

Cubbon

Paton

et al. 2018

European Heart Journal - Quality of Care and Clinical Outcomes

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Aims The UK National Institute for Health and Care Excellence (UK-NICE) and European Society of Cardiology (ESC) guidelines advise natriuretic peptide (NP) assessment in patients presenting to primary care with symptoms possibly due to chronic heart failure (HF), to determine need for specialist involvement. This prospective service evaluation aimed to describe the diagnostic and prognostic utility of these guidelines. Methods and results We prospectively collected clinical, echocardiography and outcomes data (minimum 5 years) from all patients referred to the Leeds HF Service for 12 months of following the initiation of the NP-guideline-directed pathway. Between 1 May 2012 and 1 August 2013, 1020 people with symptoms possibly due to HF attended either with a raised NT-pro-BNP or a previous myocardial infarction (MI) with an overall rate of left ventricular systolic dysfunction (LVSD) of 33%. Of these, 991 satisfied the ESC criteria (NT-pro-BNP ≥125 pg/mL) in whom the rate of LVSD was 32%, and 821 the UK-NICE criteria in whom the rate of LVSD was 49% in those with a previous MI, 25% in those with NT-pro-BNP concentration 400–2000 pg/mL, and 54% in those with NT-pro-BNP concentration of >2000 pg/mL. An NT-pro-BNP concentration 125–400 pg/mL had a 12% risk of LVSD. Specificity was poor in women >70 years, who made up the largest proportion of attendees. Elevated NT-pro-BNP levels were associated with lower survival even in the absence of LVSD. Conclusion In people referred through the ESC and UK-NICE guidelines, elevated NT-pro-BNP is a marker of increased mortality risk, but there is wide variation in specificity for LVSD. Age- and sex-adjusted criteria might improve performance.

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“…Ranking of the percentage contribution of log 2 NT-proBNP and other variables in the final model was calculated using the following formula: (the χ 2 score of the predictor variable/the global χ 2 score) × 100. If an attenuation in the ranking of the percentage contribution of NT-proBNP compared with other variables was detected within any of the BMI and eGFR categories, the incremental value of NT-proBNP levels for incident HF was evaluated with Harrell's C-statistic for that model (52,53). First, we ran a Cox regression model with all the covariates except log 2 NT-proBNP and noted the C-statistic.…”

Section: Methodsmentioning

confidence: 99%

Racial differences in the association of NT-proBNP with risk of incident heart failure in REGARDS

Patel¹,

Cushman²,

Gutiérrez³

et al. 2019

JCI Insight

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BACKGROUND. Black individuals have lower natriuretic peptide levels and greater risk of heart failure (HF) than White individuals. Higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with increased risk of incident HF, but little information is available in Black individuals. We examined race-specific differences in (a) the association of NT-proBNP with incident HF and (b) the predictive ability of NT-proBNP for incident HF across BMI and estimated glomerular filtration rate (eGFR) categories. METHODS.In a prospective case-cohort study, baseline NT-proBNP was measured among 687 participants with incident HF and 2923 (weighted 20,075) non-case randomly selected participants. Multivariable Cox proportional hazard modeling was used to assess the objectives of our study. Global Wald χ 2 score estimated from multivariable Cox models was used to assess predictive ability of NT-proBNP across BMI and eGFR categories. RESULTS.In the multivariable model, a doubling of NT-proBNP concentration was associated with greater risk of incident HF among White individuals (HR: 1.73; 95% CI: 1.55-1.94) than Black individuals (HR: 1.51; 95% CI: 1.34-1.70), with P interaction by race of 0.024. Higher NT-proBNP was the strongest predictor of incident HF across all BMI and eGFR categories among White individuals. In contrast, among Black individuals with obesity (BMI ≥ 30 kg/m 2 ) or eGFR less than 60 mL/min/1.73 m 2 , the predictive ability of NT-proBNP for incident HF was attenuated.CONCLUSIONS. The magnitude of the association of higher NT-proBNP with incident HF risk was

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B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure

Abstract: Among patients without HF, plasma BNP level is a stronger predictor of death than traditional risk factors. The risk for death associated with any given BNP level is similar between patients with and those without HF, particularly in the acute care setting.

Cited by 117 publications

References 35 publications

Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

Prospective evaluation and long-term follow-up of patients referred to secondary care based upon natriuretic peptide levels in primary care

Racial differences in the association of NT-proBNP with risk of incident heart failure in REGARDS

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