Comparative Prognostic Value of Plasma and Urinary N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Acute Destabilized Heart Failure

Manzano-Fernández, Sergio; Januzzi, James L.; García, Miguel; Bonaque-González, Juan C.; Muñoz‐Esparza, Carmen; Albaladejo-Otón, María Dolores; Pastor‐Pérez, Francisco J.; Pastor, Patricia; Valdés, Mariano; Pascual-Figal, Domingo A.

doi:10.1016/j.rec.2010.10.018

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…Blood sampling is invasive, so noninvasive assessment of urine NT-proBNP has been investigated as an alternative. The urine concentration of NT-proBNP is an acceptably accurate biomarker for diagnosing HF, with a cut-off value of 74.2 pg/mL [8], which is consistent with that observed in our patient cohort (17.2-164.4 pg/mL). A study investigating the prognostic power of urine NT-proBNP showed that the 12-month mortality and cardiac admission rate was 21% in patients with urine NT-proBNP < 92.61 pg/mL compared to 52% in those with urine NT-proBNP > 92.61 pg/mL [7].…”

Section: Discussionsupporting

confidence: 90%

The Ratio of Urine N-Terminal Pro B-Type Natriuretic Peptide to Cyclic Guanosine Monophosphate Predicts Emergency Department Visits for Heart Failure

2022

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Introduction: Emergency department (ED) visits for decompensated heart failure (HF) are frequent and associated with poor long-term outcomes. Plasma N-terminal pro b-type natriuretic peptide (NT-proBNP) and cyclic guanosine monophosphate (cGMP) are used in diagnosis and prognosis of HF patients, while clinical values of urine NT-proBNP/cGMP ratio has been rarely explored. This study aims to compare the predictive values of urine NT-proBNP/cGMP ratio versus plasma NT-proBNP for ED visits for decompensated HF. Methods: This prospective study included 126 HF patients with reduced left ventricular ejection fraction (LVEF) (< 50%) and without chronic kidney disease. Baseline data included demographics, comorbidities, and co-medications. Medical records were used to determine the incidence of ED visits for decompensated HF during the three months following the last visit. Results: Patients with subsequent ED visits had significantly higher levels of plasma and urine NT-proBNP and urine cGMP in than those without. Multivariate Cox regression analysis disclosed that Lg10urine NT-proBNP/cGMP was an independent risk factor for subsequent ED visits (OR= 3.267; 95% CI, 1.105–9.663; P = 0.032). ROC analysis revealed a Lg10urine NT-proBNP/cGMP ratio optimal cut-off value of 0.1706 (AUC, 0.700; 95% CI, 0.543–0.857; P = 0.036) for predicting subsequent heart-failure–related ED visits. Conclusion: A single measurement of urinary NT-proBNP/cGMP ratio is predictive of subsequent ED visits for decompensated HF. This non-invasive and easy measurement may be a clinically useful tool for identifying a subset of patients at higher risk of ED visits.

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Section: Discussionsupporting

confidence: 90%

The Ratio of Urine N-Terminal Pro B-Type Natriuretic Peptide to Cyclic Guanosine Monophosphate Predicts Emergency Department Visits for Heart Failure

2022

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“…5 Several studies have investigated the accuracy of urine NT-proBNP concentration as an indicator of HF prognostic parameters such as 2-month cardiac mortality 6 and acute decompensated HF. 7 One study reports that inter-subject variability in urinary NT-proBNP concentration can be decreased by correcting for urinary creatinine excretion (urine NT-proBNP/creatinine), thereby optimizing its clinical use. 8 This study aims to determine whether the NT-proBNP in fresh urine is predictive of subsequent ED visits for decompensated HF.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to its presence in serum, NT‐proBNP is excreted in urine, and the assessment of urine NT‐proBNP level is non‐invasive and easier than is testing for NT‐proBNP in serum 5 . Several studies have investigated the accuracy of urine NT‐proBNP concentration as an indicator of HF prognostic parameters such as 2‐month cardiac mortality 6 and acute decompensated HF 7 . One study reports that inter‐subject variability in urinary NT‐proBNP concentration can be decreased by correcting for urinary creatinine excretion (urine NT‐proBNP/creatinine), thereby optimizing its clinical use 8…”

Section: Introductionmentioning

confidence: 99%

Urine N‐terminal pro b‐type natriuretic peptide is predictive of heart failure‐related emergency department visits

et al. 2020

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Aims Emergency department (ED) visits for decompensated heart failure (HF) are frequent and associated with poor long-term outcomes in patients with HF. Serum N-terminal pro b-type natriuretic peptide (NT-proBNP) is widely used to assist diagnosis and predict clinical outcomes in HF patients. Few studies have investigated the use of urine NT-proBNP as an HF biomarker. This study aims to assess the value of urine NT-proBNP for predicting ED visits for decompensated HF as compared with that of serum NT-proBNP. Methods and results This study included 122 HF patients with reduced left ventricular ejection fraction (<50%). Serum and urine NT-proBNP levels were measured. Baseline data included demographics, comorbidities, and co-medications. Medical records were used to determine the incidence of visits to the ED for decompensated HF during the 3 months following the last visit. We observed significantly higher levels of both serum and urine NT-proBNP in patients with subsequent ED visits than in those without. Multivariate logistic regression analysis showed that urine NT-proBNP/creatinine ratio (OR, 1.031; 95% CI, 1.001-1.061; P = 0.046) but not serum NT-proBNP was an independent factor associated with subsequent ED visits. According to receiver-operating characteristic area under the curve analysis, the optimal cutoff value of urine NT-proBNP/creatinine ratio for predicting subsequent heart-failure related ED visits was 0.272 pg/μg Cr (area under the curve, 0.675; P = 0.011). Conclusions For HF patients with reduced left ventricular ejection fraction, a single measurement of urinary NT-proBNP/ creatinine ratio is predictive of subsequent ED visits for decompensated HF. This non-invasive and easy measurement may be a clinically useful tool for monitoring clinical outcomes and identifying a subset of patients at higher risk of ED visits within a short time.

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“…NT-proBNP is a remarkable biomarker for HF, patients with HF often present a higher level of NT-proBNP. Besides, a higher level of NT-proBNP indicates a deterioration and a poor prognosis of HF (31)(32)(33)(34)(35). Our findings suggested that vericiguat cannot significantly reduce the level of NT-proBNP.…”

Section: Discussionmentioning

confidence: 69%

sGC Stimulators for Heart Failure: A Meta-Analysis of Randomized Controlled Trials

Xueli¹,

Wang²,

Zhou³

2020

Preprint

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Background Oral sGC stimulators are novel treatments for heart failure (HF). Since individual studies are limited to confirm the efficacy and safety of sGC stimulators in patients with HF, we provide a meta-analysis based on published clinical randomized controlled trials. Methods Embase, PubMed, Cochrane and Medline were applied to search for randomized controlled trials (published before March 29, 2020 without language restrictions) by comparing oral sGC stimulators to placebos. Main endpoints were efficacy outcomes, including all-cause mortality, incidence of cardiovascular-events related death or hospitalization, alterations of EQ-5D index, and N-terminal (NT)-pro hormone BNP(NT-proBNP); and safety outcomes included incidence of serious adverse events (SAEs), symptomatic hypotension and syncope. Results Six trials were enrolled (N=6255 participants), sGC stimulators yielded a lower incidence of cardiovascular-events related death or hospitalization (OR=0.88, 95% CI=0.79 to 0.98), an improvement in EQ-5D scores (SMD=0.44, 95% CI=0.24 to 0.63), and a lower relative risk of SAEs (OR=0.90, 95% CI=0.81 to 1.00) compared with placebos. Furthermore, NT-proBNP was decreased by riociguat (SMD=-0.79, 95% CI=-1.10 to -0.49), but not by vericiguat (SMD=0.04, 95% CI=-0.18 to 0.25). There was no significant difference in all-cause mortality (OR=0.95, 95% CI=0.83 to 1.09), incidence of symptomatic hypotension (OR=1.15, 95% CI=0.95 to 1.40) and syncope (OR=1.15, 95% CI=0.87 to 1.53) between sGC stimulators and placebos. Conclusion Oral sGC stimulators may be beneficial for HF with a good tolerance, further studies are also needed to establish the optimal approach in clinical practice.

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Comparative Prognostic Value of Plasma and Urinary N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Acute Destabilized Heart Failure

Cited by 5 publications

References 18 publications

The Ratio of Urine N-Terminal Pro B-Type Natriuretic Peptide to Cyclic Guanosine Monophosphate Predicts Emergency Department Visits for Heart Failure

The Ratio of Urine N-Terminal Pro B-Type Natriuretic Peptide to Cyclic Guanosine Monophosphate Predicts Emergency Department Visits for Heart Failure

Urine N‐terminal pro b‐type natriuretic peptide is predictive of heart failure‐related emergency department visits

sGC Stimulators for Heart Failure: A Meta-Analysis of Randomized Controlled Trials

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