NT‐proBNP/BNP ratio for prognostication in European Caucasian patients enrolled in a heart failure prevention programme

Abstract

Aims Guidelines support the role of B‐type natriuretic peptide (BNP) and amino‐terminal pro‐BNP (NT‐proBNP) for risk stratification of patients in programmes to prevent heart failure (HF). Although biologically formed in a 1:1 ratio, the ratio of NT‐proBNP to BNP exhibits wide inter‐individual variability. A report on an Asian population suggests that molar NT‐proBNP/BNP ratio is associated with incident HF. This study aims to determine whether routine, simultaneous evaluation of both BNP and NT‐proBNP is warranted in a European, Caucasian population. Methods and Results We determined BNP and NT‐proBNP levels for 782 Stage A/B HF patients in the STOP‐HF programme. The clinical, echocardiographic, and biochemical associates of molar NT‐proBNP/BNP ratio were analysed. The primary endpoint was the adjusted association of baseline molar NT‐proBNP/BNP ratio with new‐onset HF and/or progression of left ventricular dysfunction (LVD). We estimated the C‐statistic, integrated discrimination improvement, and the category‐free net reclassification improvement metric for the addition of molar NT‐proBNP/BNP ratio to adjusted models. The median age was 66.6 years [interquartile range (IQR) 59.5–73.1], 371 (47.4%) were female, and median molar NT‐proBNP/BNP ratio was 1.91 (IQR 1.37–2.93). Estimated glomerular filtration rate, systolic blood pressure, left ventricular mass index, and heart rate were associated with NT‐proBNP/BNP ratio in a linear regression model (all P < 0.05). Over a median follow‐up period of 5 years (IQR 3.4–6.8), 247 (31.5%) patients developed HF or progression of LVD. Log‐transformed NT‐proBNP/BNP ratio is inversely associated with HF and LVD risk when adjusted for age, gender, diabetes, hypertension, vascular disease, obesity, heart rate, number of years of follow‐up, estimated glomerular filtration rate, and baseline NT‐proBNP (odds ratio 0.71, 95% confidence interval 0.55–0.91; P = 0.008). However, molar NT‐proBNP/BNP ratio did not increase the C‐statistic (Δ −0.01) and net reclassification improvement (0.0035) for prediction of HF and LVD compared with NT‐proBNP or BNP alone. Substitution of NT‐proBNP for BNP in the multivariable model eliminated the association with HF and LVD risk. Conclusions This study characterized, for the first time in a Caucasian Stage A/B HF population, the relationship between NT‐proBNP/BNP ratio and biological factors and demonstrated an inverse relationship with the future development of HF and LVD. However, this study does not support routine simultaneous BNP and NT‐proBNP measurement in HF prevention programmes amongst European, Caucasian patients.

Serum a‐1 antitrypsin as a novel biomarker in chronic heart failure

“… 19 , 20 , 21 , 22 NT‐proBNP have been demonstrated to be associated with the severity and adverse outcomes of HF. 23 , 24 In our study, we demonstrated that AAT concentration was increased in patients with decreased LVEF. Compared with patients with LVEF ≥ 50%, the serum AAT concentrations were significantly increased in patients with 40% ≤ LVEF < 50% and with LVEF < 40%.…”

“…NT‐proBNP, a neuro‐hormone synthesized in the cardiac ventricles in response to increased wall tension, is an established biomarker of HF 19–22 . NT‐proBNP have been demonstrated to be associated with the severity and adverse outcomes of HF 23,24 . In our study, we demonstrated that AAT concentration was increased in patients with decreased LVEF.…”

Risk of heart failure depending on the state of renal filtration function in patients with uncomplicated hypertension

“…Имеются сведения о том, что более высокий уровень N-терминального фрагмента промозгового натрийуретического пептида (NT-proBNP) у больных без симптомов и признаков недостаточности кровообращения статистически значимо связан с развитием ХСН, независимо от возраста, пола, этнической принадлежности, систолического АД, сахарного диабета, курения, расчетной скорости клубочковой фильтрации (СКФ), препаратов (антигипертензивные средства и статины), индекса массы миокарда левого желудочка (ИММЛЖ) и инфаркта миокарда (относительный риск (RR) =1,95 на 1U логарифмический прирост NT-proBNP, 95% ДИ =1,54-2,46, Р<0,001) [4]. При этом расчетная СКФ, систолическое АД, ИММЛЖ и частота сердечных сокращений были ассоциированы с соотношением NT-proBNP/ BNP в модели линейной регрессии (все P<0,05).…”

Exercise-induced secretion of NT-pro BNP in asymptomatic hypertensive patients with type 2 diabetes mellitus – an early sign of subclinical ventricular dysfunction

“…They are used in diagnosing and tailoring the management of congestive heart failure [3]. The ESC guidelines included these biomarkers in the risk strati cation for evolution and complications in heart failure patients [4].…”