The Association of Five-Year Changes in the Levels of N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP) with Subsequent Heart Failure and Death in Patients with Stable Coronary Artery Disease: The Heart and Soul Study

Abstract

Background: The N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) is a powerful predictor of adverse outcomes in patients with coronary artery disease (CAD). However, little is known regarding the prognostic significance of longitudinal changes in NT-proBNP levels. Methods: We evaluated the ability of 5-year changes in NT-proBNP levels to predict subsequent heart failure (HF) hospitalization or cardiovascular (CV) death in 635 participants with stable CAD enrolled in the Heart and Soul Study. Results: The median (IQR) 5-year change in NT-proBNP was 50 pg/mL (-5 to +222). During an average of 4.0 ± 1.4 years follow-up (i.e., 9 years from the baseline measurement), there were 67 events. Participants with 5-year changes in the highest quartile (≥ 223 pg/mL increase in NT-proBNP) had an almost 4-fold greater risk of subsequent HF or CV death than those in the lowest quartile of ≤-5 pg/mL (HR 3.8; 95% CI 2.0-7.3; p < 0.001). This association remained strong after adjustment for demographic variables, comorbidities, left ventricular mass index, systolic and diastolic function, and baseline and follow-up NT-proBNP levels (HR 3.9; 95% CI 1.1-13.4; p = 0.01). Conclusion: Changes in NT-proBNP levels at 5 years predict subsequent HF or CV death in patients with stable CAD, independent of other prognostic markers, including baseline and follow-up NT-proBNP levels. A stable NT-proBNP level predicts a low risk of subsequent events.

Association of N-terminal pro B-type natriuretic peptide (NT-proBNP) change with the risk of atrial fibrillation in the ARIC cohort

“…Investigators from the Heart and Soul Study have reported that among patients with stable CVD, an increase of NT-proBNP was an independent predictor of subsequent HF and CV death over a long period of time. 25 These previous results are consistent with our findings, given the known association between HF and AF, through common risk factors and as causes of each other. 26, 27 Though not directly relevant, repeated measurements of NT-proBNP might provide predictive information on the risk of cardiovascular mortality among persons with AF.…”

Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease

“… 86 , 87 High levels of NT-proBNP are associated with vulnerable plaque components 88 and have been shown to predict outcome in patients with coronary heart disease and patients who experienced an ischemic stroke. 89 , 90 In PAD patients, similar results have been published with a strong association between all-cause mortality and increased NT-proBNP levels. The association with MACE and NT-proBNP is less frequently studied but also showed a moderately increased risk.…”

Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease

“…NT-proBNP is a cleavage product of proBNP that is released by the myocardium in response to left ventricular wall stress [18,19]. In patients with stable coronary artery disease, relevant coronary stenosis may cause transient myocardial ischemia, thereby probably increasing wall stress and releasing natriuretic peptides [20].…”