Prognostic prediction in acute heart failure patients with extreme BNP values

Abstract

Background: Some patients have good prognosis despite elevated B-type natriuretic peptide (BNP), while others have ominous outcome with low BNP. We aimed at characterising these groups of patients. Methods: We analysed patients prospectively included in an acute HF registry. Vital status within 1-year post discharge was ascertained. A receiver-operating characteristic curve was used to define discharge BNP cut-offs for 1-year death prediction. Among survivors, we compared patients with low and not-low BNP (cut-off 400 pg/mL); and among non-survivors those with high vs not-high BNP (cut-off 2000 pg/mL). In the specific subgroups of patients with low and high BNP, mortality predictors were assessed with multivariate Cox-regression analysis. Results: We studied 584 patients, median age 78 years, 62.5% had HF with reduced ejection fraction; and 199 (34.1%) died during the first year. Non-survivors were very homogeneous irrespective of BNP, survivors were substantially different. In patients discharged with BNP <400 pg/mL, increasing age independently predicted death; when BNP !2000 pg/mL death predictors were higher NYHA class, and non-use of evidence-based therapy. BNP was outcome associated in both groups. Conclusions: Different prognostic predictors may play a role in different BNP levels. We suggest that risk stratification in HF would probably be more accurate if made on top of BNP knowledge.

Long-Term Maintenance of Normal Serum Vitamin B₁ Levels Is Associated with Better Outcomes in Patients with Heart Failure

“…The parameters with P < 0.05 in univariate analysis; brain natriuretic peptide (BNP); LVEF; and beta-blocker/ivabradine, ACE-I/ ARB/ARNI, and MRA prescriptions were reported as the predictors of composite outcome for patients with HF enrolled in previous studies. [21][22][23][24] The odds ratios of continuous variables indicate the unit odds ratios and those of II. A significant difference in serum albumin concentrations and PNI was noted among the 3 groups.…”

“…No significant correlation was observed between VB1 and nutrition indexes PNI (r = 0.15, P = 0.18; GNRI: r = 0.04, P = 0.72). In the longterm maintenance group, the blood VB1 concentration at the end of treatment (118 [63-258] days after the start of fursultiamine administration) was 161 [67-302] ng/mL, which was significantly higher than that at the baseline blood VB1 concentration (20 [14][15][16][17][18][19][20][21][22] ng/mL, P < 0.01). Echocardiographic data: Echocardiographic data are summarized in Table III.…”