Can B‐type natriuretic peptides replace heart failure risk models?

Inflammatory cytokines as biomarkers in heart failure

“…For cytokines that remain significant in multivariable analysis with NT-proBNP and CRP, the gain in discriminatory power is modest at best. However, the marginal incremental value of inflammatory cytokines in HF progression is not surprising given the limited value even NT-proBNP offers beyond any well-constructed multivariable risk model [59].…”

“…However, in spite of their prognostic power, even the use of natriuretic peptides has limitations related to poor performance in certain demographics, such as patients with obesity and renal impairment, as well as the interpretation of midrange "gray-zone" levels [58]. In addition, the natriuretic peptides do not reflect all underlying pathological processes in the failing myocardium, and only modestly improve well-constructed multivariable risk models [59]. Indeed, measurement of hs-cTn provides significant prognostic information independent of NT-proBNP in chronic HF, and simultaneous measurement of hs-cTn and NT-proBNP improves mortality risk stratification in these patients [15][16][17].…”

“…While logical from a clinical point of view, such comparisons may be unfortunate from a mechanistic standpoint. Despite their usefulness, the natriuretic peptides have several limitations [58,59]. However, they perform quite well in statistical evaluations of prognostic utility, and may therefore preclude further investigations into novel markers if novel markers are evaluated on statistical basis alone.…”

Multivariate Risk Scores and Patient Outcomes in Advanced Heart Failure

“…The states of hyponatremia, 11 anemia, 12 hypoalbuminemia, 13 and excessive circulating cytokine levels 14 all show independent association with worsened survival. B‐type natriuretic peptides (BNPs) have probably received the most attention in the recent literature as a single laboratory biomarker of outcome 15–18 . The quartile of patients with the lowest N‐terminal pro–brain natriuretic peptide (NT‐proBNP) levels in the placebo arm of the Valsartan Heart Failure Trial (Val‐HeFT) had less than one third the mortality (7.8%) of patients in the highest quartile of NT‐proBNP (25.3%) 19 .…”

“…B-type natriuretic peptides (BNPs) have probably received the most attention in the recent literature as a single laboratory biomarker of outcome. [15][16][17][18] The quartile of patients with the lowest N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in the placebo arm of the Valsartan Heart Failure Trial (Val-HeFT) had less than one third the mortality (7.8%) of patients in the highest quartile of NT-proBNP (25.3%). 19 In addition, change in BNP level provided additional prognostic information over the value at a single point in time.…”