How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review

Abstract

Objective To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure. Design Systematic review of studies assessing BNP for prognosis in patients with heart failure or asymptomatic patients. Data sources Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies. Study selection and data extraction We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. Multivariable models that included both BNP and left ventricular ejection fraction as predictors were used to compare the prognostic value of each variable. Two reviewers independently selected studies and extracted data. Data synthesis 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients. In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death. BNP was used in 35 multivariable models of prognosis. In nine of the models, it was the only variable to reach significance-that is, other variables contained no prognostic information beyond that of BNP. Even allowing for the scale of the variables, it seems to be a strong indicator of risk. Conclusion Although systematic reviews of prognostic studies have inherent difficulties, including the possibility of publication bias, the results of the studies in this review show that BNP is a strong prognostic indicator for both asymptomatic patients and for patients with heart failure at all stages of disease.

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

“…BNP is secreted primarily by cardiac myocytes in response to increase in LV wall stress, resulting in myocyte stretch, and the BNP level shows good correlation with LV end‐diastolic pressure. BNP levels are associated with HF severity across the spectrum of HF stages 9, 10, 11. In the current study, the BNP levels showed a significantly independent predictive value for poor prognosis in patients with HFrEF, HFpEF, and HFrlEF.…”

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

“…B-type natriuretic peptide (BNP) and the N-terminal proBNP fragment (NTproBNP) are both powerful predictors of outcome in patients with heart failure at all stages of disease [2]. Recently, data from the Framingham Heart Study identified BNP as a strong predictor of morbidity and mortality in the general population even when BNP levels were below the threshold normally used to diagnose patients with heart failure [3].…”

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

“…Use of b‐type natriuretic peptide (BNP) and the physiologically inert cleaved fragment, N‐terminal‐pro‐b‐type natriuretic peptide (NT‐proBNP), are guideline recommended by for the evaluation of dyspnea 2, 3. BNP and/or NT‐proBNP levels correlate with HF diagnosis, severity, and mortality 4, 5. However, obesity may be associated with lower circulating levels of BNP and/or NT‐proBNP 6, 7, 8, 9.…”