Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure

Koglin, Jörg; Pehlivanli, Sinan; Schwaiblmair, Martin; Vogeser, Michael; Cremer, P.; vonScheidt, Wolfgang

doi:10.1016/s0735-1097(01)01672-2

Cited by 373 publications

(118 citation statements)

References 28 publications

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“…Several previous studies [6,7,8,9] have shown N-BNP or BNP to be of prognostic significance in patients with CHF, as good as or better than LVEF or peak VO 2 at predicting death or cardiac events. However, in the studies by Gardner et al [6], Zugck et al [8] and Isnard et al [9], the patients had more severe CHF as reflected by a lower peak VO 2 of 11.8 [6], 14.9 [8] and 16.8 ml/kg/min [9] and a lower LVEF of 15 [6], 22 [8] and 29% [9].…”

Section: Discussionmentioning

confidence: 99%

“…However, in the studies by Gardner et al [6], Zugck et al [8] and Isnard et al [9], the patients had more severe CHF as reflected by a lower peak VO 2 of 11.8 [6], 14.9 [8] and 16.8 ml/kg/min [9] and a lower LVEF of 15 [6], 22 [8] and 29% [9]. Although the study population in the investigation by Koglin et al [7] had a similar LVEF to our cohort (36%), the peak VO 2 was much lower (15 ml/kg/min). Moreover, none of these studies included exercise duration and peak exercise SBP in their multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…These include grading of symptoms by the New York Heart Association (NYHA) functional classification [2], obtained by history taking and the widely used (especially in clinical trials) assessment of left ventricular ejection fraction (LVEF) [3]. Previous studies have also shown exercise-derived indicators such as peak oxygen consumption (VO 2 ) [4] and higher levels of plasma brain natriuretic peptide (BNP) to be helpful in risk stratification and prognostic assessment [5,6,7,8,9]. Many of these studies pertain to patients with severe heart failure or were part of large pharmaceutical clinical trials, and therefore, may not be representative of patients seen in an average clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Exercise Duration and Peak Systolic Blood Pressure Are Predictive of Mortality in Ambulatory Patients with Mild-Moderate Chronic Heart Failure

Williams

Jackson

et al. 2005

Cardiology

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Background and Aims: It is a prevailing concept in chronic heart failure (CHF) that ventricular remodelling (evaluated via imaging) and neurohormonal activation (via biomarkers) exert major influences, such that the need to subject patients to haemodynamic evaluations and exercise testing has been questioned. We sought to investigate whether exercise and haemodynamic parameters lack independent prognostic value in a cohort of unselected ambulatory patients with mild-moderate CHF. Methods: Eighty-five consecutive patients with stable CHF in New York Heart Association functional classes I–IV, aged 55 ± 12 years, 84% males, left ventricular ejection fraction (LVEF) 37 ± 15%, participated in this study. Survivors were followed for a median of 5.08 years. All subjects underwent cardiopulmonary exercise testing to measure standard parameters including peak oxygen consumption, exercise duration and blood pressure. A sample of venous blood was taken to determine the N-terminal pro-brain natriuretic peptide (N-BNP) level. Echocardiography was performed at rest to measure LVEF. Predictors of mortality were sought using the Cox proportional hazards model. Results: All-cause mortality was 19% (16 deaths, 95% CI 11–29%). Age and LVEF did not independently predict mortality. Although various parameters including New York Heart Association class, peak oxygen consumption and N-BNP level were all predictive of outcome on univariate analysis, multivariate analysis identified reduced exercise duration and peak systolic blood pressure (SBP) to be the only independent predictors of all-cause mortality. Hazard ratios of 0.78 (95% CI 0.65–0.93, p = 0.007) and 0.79 (95% CI 0.66–0.95, p = 0.01) were associated with an increase in exercise duration of 1 min and 10 mm Hg peak SBP, respectively. Conclusions: Two simple parameters (exercise duration and peak SBP) that are easily measured by standard exercise testing are the strongest independent predictors of mortality which outperform LVEF and N-BNP in ambulatory patients with mild-moderate CHF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exercise Duration and Peak Systolic Blood Pressure Are Predictive of Mortality in Ambulatory Patients with Mild-Moderate Chronic Heart Failure

Williams

Jackson

et al. 2005

Cardiology

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“…In another study, plasma BNP provided important prognostic information in patients with chronic HF, independently of the cause of the disease. In comparison to lower levels, high circulating levels of BNP were associated with high incidence of death or attacks of decompensation [24].…”

Section: Discussionmentioning

confidence: 90%

Salivary B-type natriuretic peptide: a new method for heart failure diagnosis and follow-up

2017

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A b s t r a c tBackground: Frequent hospital admissions and reduced quality of life are the main complications of heart failure (HF). Plasma B-type natriuretic peptide (BNP) levels have been considered as a cost-effective method of screening for left ventricular dysfunction. Studies regarding BNP-guided therapy revealed reduction in death or hospital stay for HF. Aim:As saliva has fewer limitations than blood in regard to sampling, the aim of the present study was to test if salivary BNP concentration might be a new biomarker in patients with chronic HF.Methods: This pilot study involved 35 admitted patients with decompensated HF diagnosis and 35 HF patients who had come for a check-up at the Department of Cardiology. The control group consisted of 25 people with no history of cardiac events. Saliva and plasma samples of all the participants were collected.Results: Mean plasma NT-proBNP was found at higher levels in admitted HF patients compared to outpatient HF (9.37 vs. 6.62 pg/mL, p < 0.001) and control groups (9.37 vs. 4.69 pg/mL, p < 0.001). Also, mean salivary BNP levels were higher in admitted patients with HF (6.50 ng/L, p < 0.001); and outpatient HF group (5.87 ng/L, p = 0.02) compared to the control group (5.64 ng/L). Conclusions:Our study demonstrated that BNP could be detected in saliva and that the level is higher in HF patients, especially symptomatic ones. This means that salivary BNP may be useful in the diagnosis and follow-up for patients with HF, especially in emergency settings.

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“…Elevated levels of BNP have been shown in patients with CHF of any cause including diastolic dysfunction and valvular disease and correlate with functional class as well as with prognosis [15,16,17,18]. In addition, BNP levels have been shown to correlate with prognosis in patients following acute coronary syndromes [19].…”

Section: Introductionmentioning

confidence: 99%

Brain Natriuretic Peptide Levels Predict Perioperative Events in Cardiac Patients Undergoing Noncardiac Surgery: A Prospective Study

et al. 2007

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Objectives: Brain natriuretic peptide (BNP) levels correlate with prognosis in patients with cardiac disease and may be useful in the risk stratification of cardiac patients undergoing noncardiac surgery (NCS). The objective of this study was to examine whether BNP levels predict perioperative events in cardiac patients undergoing NCS. Methods: Patients undergoing NCS with at least 1 of the following criteria were included: a clinical history of congestive heart failure (CHF), ejection fraction <40%, or severe aortic stenosis. All patients underwent echocardiography and measurement of BNP performed using the ADVIA-Centaur BNP assay (Bayer HealthCare). Clinical endpoints were death, myocardial infarction or pulmonary congestion requiring intravenous diuretics at 30 days of follow-up. Results: Forty-four patients were entered into the study; 15 patients (34%) developed cardiac postoperative complications. The mean BNP level was 1,366 ± 1,420 pg/ml in patients with events and 167 ± 194 pg/ml in patients without events, indicating a highly significant difference (p < 0.001). The ROC area under the curve was 0.91 (95% CI 0.83–0.99) with an optimal cutoff of >165 pg/ml (100% sensitivity, 70% specificity). Conclusions: BNP levels may predict perioperative complications in cardiac patients undergoing NCS, and the measurement of BNP should be considered to assess the preoperative cardiac risk.

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Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure

Abstract: Measurement of plasma BNP concentrations might provide a useful and cost-effective screening tool that helps reduce the need and frequency for more expensive cardiac tests.

Cited by 373 publications

References 28 publications

Exercise Duration and Peak Systolic Blood Pressure Are Predictive of Mortality in Ambulatory Patients with Mild-Moderate Chronic Heart Failure

Exercise Duration and Peak Systolic Blood Pressure Are Predictive of Mortality in Ambulatory Patients with Mild-Moderate Chronic Heart Failure

Salivary B-type natriuretic peptide: a new method for heart failure diagnosis and follow-up

Brain Natriuretic Peptide Levels Predict Perioperative Events in Cardiac Patients Undergoing Noncardiac Surgery: A Prospective Study

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