Prognosis of Stage A or B Heart Failure Patients With Elevated B-type Natriuretic Peptide Levels
Received 21 April 2009; received in revised form 26 September 2009; accepted 8 October 2009. published online 16 November 2009.
Abstract
Background
Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients.
Methods and Results
Outpatients referred for echocardiogram (n=829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62–2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11–3.28).
Conclusions
Individuals without any history of HF but with BNP ≥100pg/mL are at equal or higher risk than those with a HF history whose BNP is <100pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events.
1Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, CA
2Veteran's Affairs San Diego Healthcare System, La Jolla, CA
Reprint requests: Lori B. Daniels, MD, MAS, Mail Code 0986, 9350 Campus Point Dr., Suite 1D, La Jolla, CA 92037-1300. Tel: (858) 775-9214; Fax: (858) 657-8021.
Supported in part by a grant from the American College of Cardiology/Guidant Foundation, Bethesda, MD (L.B.D.). Abbott Inc. supplied the reagents for analyzing the biomarkers for this report, but had no input into data acquisition, data analysis, manuscript preparation, or any other aspect of the study. A.S.M. has received research grants from Abbott, Roche, and Bayer, and is a consultant for Biosite. L.B.D. has received research support from Roche and Biosite; there are no other conflicts of interest to report.
ABSTRACT