European Heart Journal Advance Access published online on February 9, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn023
Usefulness of clinical and NT-proBNP Monitoring for prognostic guidance in destabilized heart failure outpatients
1 Department of Cardiology, University Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, 30120 Murcia, Spain
2 Department of Medicine, Universitat Autonoma de Barcelona, University Hospital Santa Creu i Sant Pau, Barcelona, Spain
3 Department of Bioquimica, University Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, 30120 Murcia, Spain
4 Statistics Department, University Hospital Santa Creu i Sant Pau, Barcelona, Spain
5 Department of Bioquimica, Universidad Autonoma de Barcelona, University Hospital Santa Creu I Sant Pau, Barcelona, Spain
6 Department of Cardiology, Massachusetts General Hospital, Boston, USA
Received 12 July 2007; revised 27 July 2007; accepted 10 January 2008.
* Corresponding author. Tel: +34 968369445, Fax: +34 968369662, Email: dapascual{at}servicam.com
Aims: To study the relative prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) monitoring in addition to clinical disease severity scores (CDSSs) in outpatients with destabilized heart failure (HF).
Methods and results: Seventy-one outpatients with recently destabilized HF were recruited. At baseline, and at all following visits, a CDSS based on Framingham criteria was obtained, and NT-proBNP levels were measured in a blind fashion. CDSS did not correlate with NT-proBNP levels at any time (P > 0.1), although their relative changes correlated during follow-up (P < 0.001). Forty patients (56%) had clinical events (cardiovascular death and/or HF hospitalization) within 1 year of follow-up. Changes in CDSS from baseline were not predictive of subsequent events (P > 0.1 for all visits), whereas changes in NT-proBNP levels were predictive at several time points: week 2 (P = 0.005), week 3 (P = 0.037), week 4 (P = 0.015), and 6 months (P = 0.026). A change in NT-proBNP levels at follow-up week 2 (%) added independent prognostic information (P < 0.001, HR 0.982, 95% CI 0.972–0.992) to baseline CDSS (P = 0.002, HR 2.05, 95% CI 1.290–3.266), age (P = 0.007, HR 1.034, 95% CI 1.009–1.059), and left ventricular ejection fraction (P = 0.013, HR 0.942, 95% CI 0.898–0.987).
Conclusion: Serial monitoring for per cent change in NT-proBNP concentrations offers superior prognostic information to clinical assessment among outpatients with recent destabilized HF.
Key Words: B-type natriuretic peptide • Clinical score • Heart failure • Outpatient • Prognosis
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