Prognostic utility of the N terminal prohormone of brain natriuretic peptide and the modified Model for End Stage Liver Disease in patients with end stage heart failure

Abstract

INTRODUCTION The N terminal prohormone of brain natriuretic peptide (NT proBNP) is secreted by cardiomyocytes in response to increased wall stress resulting from pressure and volume overload. The modified Model for End Stage Liver Disease (modMELD) scale reflects the systemic effect of heart failure (HF), which includes end-organ congestion and subsequent hepatic and renal dysfunction. OBJECTIVES The aim of this study was to assess the prognostic accuracy of NT proBNP and the modMELD score, as well as to compare their usefulness in the risk stratification of patients with end-stage HF awaiting orthotopic heart transplantation (OHT). PATIENTS AND METHODS We retrospectively analyzed the data of 641 consecutive adult patients awaiting OHT between 2012 and 2016. Exclusion criteria included "urgent status", OHT, and removal from the waiting list. Clinical and laboratory data were obtained at the time of admission to the waiting list. The primary endpoint was all-cause mortality during a one-year follow up. RESULTS In the overall population of 370 patients, the median age was 54.0 (46.0-60.0) years, and 87.6% of the patients were male. During the follow-up period, the mortality rate was 27.6%. The areas under the curve (AUCs) were 0.619 (95% CI: 0.557-0.681) for NT proBNP and 0.870 (95% CI: 0.833-0.906) for modMELD. The difference between the AUC for modMELD and NT proBNP was 0.251 (95% CI: 0.179-0.322, P <0.0001). CONCLUSIONS The usefulness of NT proBNP in evaluating the prognosis of patients with end stage HF awaiting OHT is limited. The modMELD score is a better prognostic marker of waiting list mortality than the NT proBNP serum concentration.

Apelin Improves Prognostic Value of HFSS (Heart Failure Survival Score) and MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) Scales in Ambulatory Patients with End-Stage Heart Failure

“…However, NT-proBNP slightly improved the prognostic power of the HFSS score to predict one-year mortality in the analyzed group of patients. Natriuretic peptides play an important regulatory role in responding to the increase in ventricular volume by opposing vasoconstriction, sodium retention and antidiuretic effects of the activated renin-angiotensin-aldosterone system [ 12 , 21 ]. In clinical practise, NT-proBNP is commonly used to aid the diagnosis of HF, assess the effect of therapy and predict the outcomes at different stages of HF [ 1 , 22 , 23 , 24 ].…”

“…These conditions may limit the value of NT-proBNP to predict survival in patients with end-stage HF. Furthermore, as our previous study has shown [ 12 ], the relatively limited prognostic power of NT-proBNP may result from the fact that our population included a selected optimally treated group of stable patients with end-stage HF. Optimal neurohormonal suppression with maximal HF therapy may also limit the prognostic performance of this marker and contribute to the lack of significant improvement of prognostic strength in the combination of NT-proBNP with HFSS and MAGGIC, as compared to adding apelin to these scales.…”

“…Furthermore, patients with HF constitute an etiologically and functionally heterogeneous group, which generally makes it difficult to accurately assess the prognosis with the use of any individual parameters [ 7 , 8 , 9 ]. It seems that prognostic scales that enable a holistic assessment of patient prognosis, are a more reliable tools for assessing the risk of death [ 5 , 9 , 10 , 11 , 12 , 13 ]. Although there are many risk models with their own set of advantages and disadvantages in end-stage HF, including the Heart Failure Survival Score (HFSS) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score [ 11 , 14 ], there is still a critical need to improve reliable prognostic tools in ambulatory patients listed for heart transplantation (HT).…”

Use of bedside ultrasound to assess fluid status: a literature review

“…failure In everyday clinical practice, the assessment of HF exacerbation is based on clinical examination, chest radiography, N -terminal fragment of the prohormone brain natriuretic peptide (NT -proBNP) levels, and echocardiography. 30,31 Physical examination is still the initial diagnostic modality. However, it does not yield reliable results in asymptomatic patients and does not allow for a precise assessment of the degree of HF exacerbation.…”

Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension

“…Developing a CF -LVAD-dedicated risk scale including hemodynamic, clinical, and biochemical factors-predictors of survival, could also be helpful in determining an optimal time frame for OHT during LVAD support, as it has been explored in some studies of non -LVAD patients with endstage HF who awaited OHT. 22,23 Study limitations Our study had some limitations owing to its retrospective design. In several patients, data were missing, including information on RHC before implantation.…”