Prognostic value of NT-proBNP in heart failure with preserved versus reduced EF

Kang, Sang‐Won; Park, Jin Joo; Choi, Dong‐Ju; Yoon, Chang Hwan; Oh, Il-Young; Kang, Seok-Min; Yoo, Byung‐Su; Jeon, Eun‐Seok; Kim, Jae‐Joong; Cho, Myeong Chan; Chae, Shung Chull; Ryu, Kyu-Hyung; Oh, Byung‐Hee

doi:10.1136/heartjnl-2015-307782

Cited by 126 publications

(107 citation statements)

References 33 publications

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“…BNP levels are associated with HF severity and are a reliable predictor of prognosis throughout the stages of HF 9, 10, 11. In addition, recent reports show that elevated BNP levels are associated with poor prognosis in patients with HFpEF as well as in those with HFrEF 12, 13. Accordingly, the current study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF.…”

Section: Introductionmentioning

confidence: 94%

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

et al. 2017

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AimsCardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF.Methods and resultsThe study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J‐MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40–60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event‐free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178–14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969–44.608, P < 0.001) but not in HFrhEF patients (P = 0.767).ConclusionsThe BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF.

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Section: Introductionmentioning

confidence: 94%

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

et al. 2017

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“…ROC analysis of 6-month death further showed that CCN1 could predict events in AHF patients as effectively as NT-proBNP. NT-proBNP that is released in response to volume expansion and pressure overload is a well-established biomarker in predicting heart failure [27,28], and CCN1 has been shown to be involved in the regulation of fibrogenesis associated with cardiac remodeling. The use of a combination of biomarkers associated with different pathophysiological pathways could produce additive prognostic information.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Serum Cysteine-Rich Protein 61 in Patients with Acute Heart Failure

Zhao

Zhang

Liu

et al. 2018

Cell Physiol Biochem

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Background/Aims: Cyr61-cysteine-rich protein 61 (CCN1/CYR61) is a multifunctional matricellular protein involved in the regulation of fibrogenesis. Animal experiments have demonstrated that CCN1 can inhibit cardiac fibrosis in cardiac hypertrophy. However, no study has been conducted to assess the relation between serum CCN1 and prognosis of acute heart failure (AHF). Methods: We measured the serum CCN1 levels of 183 patients with AHF, and the patients were followed up for 6 months. The associations between CCN1 levels and some clinical covariates, especially left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), atrial fibrillation and age, were estimated. The AHF patients were followed up for 6 months. The endpoint was all-cause mortality. Kaplan-Meier curve analysis and multivariable Cox proportional hazards analysis were employed to evaluate the prognostic ability of CCN1. We used calibration, discrimination and reclassification to assess the mortality risk prediction of adding CCN1. Results: Serum CCN1 concentrations in AHF patients were significantly increased compared with those in individuals without AHF (237 pg/ml vs. 124.8 pg/ml, p< 0.001). CCN1 level was associated with the level of NT-proBNP (r=0.349, p< 0.001) and was not affected by LVEF, eGFR, age or atrial fibrillation in AHF patients. Importantly, Kaplan-Meier curve analysis illustrated that the AHF patients with serum CCN1 level > 260 pg/ ml had a lower survival rate (p< 0.001). Multivariate Cox hazard analysis suggests that CCN1 functions as an independent predictor of mortality for AHF patients (LgCCN1, hazard ratio 5.825, 95% confidence interval: 1.828-18.566, p=0.003). In addition, the inclusion of CCN1 in the model with NT-proBNP significantly improved the C-statistic for predicting death (0.758, p< 0.001). The integrated discrimination index was 0.019 (p< 0.001), and the net reclassification index increased significantly after addition of CCN1 (23.9%, p=0.0179). Conclusions: CCN1 is strongly predictive of 6-month mortality in patients with AHF, suggesting serum CCN1 as a promising candidate prognostic biomarker for AHF patients.

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“…A recent study by Kang et al analyzed 528 HFpEF and 1,142 HFrEF patients from the KorHF registry, and showed that the plasma level of NT-proBNP is a powerful prognostic factor in both HFpEF and HFrEF. 20 In addition, we controlled the effect of LVEF in multivariable analysis. Therefore, it may be hard to consider a higher incidence of HFpEF in women than in men as a potential mechanism for gender-specific value of NT-proBNP.…”

Section: Fundingmentioning

confidence: 99%

Gender Difference in the Prognostic Value of N-Terminal Pro-B Type Natriuretic Peptide in Patients With Heart Failure　― A Report From the Korean Heart Failure Registry (KorHF) ―

Kim

Choi

et al. 2017

Circ J

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Prognostic value of NT-proBNP in heart failure with preserved versus reduced EF

Abstract: Plasma level of NT-proBNP is the most powerful prognostic factor in both HFpEF and HFrEF. Although patients with HFpEF have lower NT-proBNP levels, the prognosis of a patient with HFpEF expected from a given NT-proBNP level is similar with his/her counterpart with HFrEF.

Cited by 126 publications

References 33 publications

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

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

Prognostic Significance of Serum Cysteine-Rich Protein 61 in Patients with Acute Heart Failure

Gender Difference in the Prognostic Value of N-Terminal Pro-B Type Natriuretic Peptide in Patients With Heart Failure　― A Report From the Korean Heart Failure Registry (KorHF) ―

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Prognostic value of NT-proBNP in heart failure with preserved versus reduced EF

Abstract: Plasma level of NT-proBNP is the most powerful prognostic factor in both HFpEF and HFrEF. Although patients with HFpEF have lower NT-proBNP levels, the prognosis of a patient with HFpEF expected from a given NT-proBNP level is similar with his/her counterpart with HFrEF.

Cited by 126 publications

References 33 publications

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

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

Prognostic Significance of Serum Cysteine-Rich Protein 61 in Patients with Acute Heart Failure

Gender Difference in the Prognostic Value of N-Terminal Pro-B Type Natriuretic Peptide in Patients With Heart Failure ― A Report From the Korean Heart Failure Registry (KorHF) ―

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Gender Difference in the Prognostic Value of N-Terminal Pro-B Type Natriuretic Peptide in Patients With Heart Failure　― A Report From the Korean Heart Failure Registry (KorHF) ―