Predictors of elevated NT-pro-BNP in cardiovascular patients without acute heart failure.

AIM: B-type natriuretic peptides are recommended for evaluation of acute heart failure. Aim of this study was to identify predictors of pathologically elevated NT-pro-BNP in patients without acute heart failure. METHOD: NT-pro-BNP was measured in 486 inpatients with cardiovascular disease and the association with clinical and laboratory parameters was examined. Elevated NT-pro-BNP was defined according to rule-in cut-off values for acute heart failure: 450 pg/ml for age <50 years, 900 pg/ml for 50-75 years and 1800 pg/ml for >75 years. RESULTS: Multivariate analysis of variables assessable without echocardiography revealed fibrinogen, albumin, atrial fibrillation, history of heart failure and diuretic use as independent predictors of pathological NT-pro-BNP. The odds for pathological NT-pro-BNP were 2.5, 8.8, 27 and 41 in the presence of 1, 2, 3 and 4/5 predictors, respectively. After adjusting for cardiac dysfunction, fibrinogen, albumin, history of heart failure and atrial fibrillation still remained significant. CONCLUSION: Assessment of these parameters could help avoid wrong positive interpretation of NT-pro-BNP results.

NT-pro-BNP is associated with long-term outcome in a heterogeneous sample of cardiac inpatients.

BACKGROUND: B-type natriuretic peptides (NP) are excellent predictors of mortality in selected patients with heart failure and coronary heart disease. Up to now, the association of NPs with cardiovascular outcome has not been evaluated in multi-morbid populations with a broad spectrum of cardiovascular disease. METHODS: NT-pro-BNP was measured at discharge in 615 inpatients from a cardiology department of a university hospital. The association of discharge NT-pro-BNP with long-term outcome was examined during a median follow-up time of 1130 days. RESULTS: NT-pro-BNP was significantly elevated in patients who died, developed ischemic stroke, or were hospitalized due to acute heart failure, but not in patients who developed myocardial infarction or underwent coronary angioplasty compared to patients without any endpoint. Patients with supramedian NT-pro-BNP values (>339 pg/ml) had significantly worse outcomes with respect to the combined endpoint (CE) of death, heart failure hospitalization, and stroke than patients with inframedian NT-pro-BNP values. After adjusting for age, gender, renal function, NYHA class, presence of diabetes, coronary 3-vessel disease, systolic and valvular dysfunction, NT-pro-BNP was a significant predictor of the CE. The AUC for NT-pro-BNP to predict the CE was 0.79 in the total population, 0.81 in patients with coronary heart disease or acute heart failure, and 0.74 in patients with other diagnoses. A NT-pro-BNP cut-off value of 240 pg/ml revealed a negative predictive value of more than 93% in all three groups. CONCLUSION: In a heterogeneous population of hospitalized cardiac patients, NT-pro-BNP measured at discharge predicts a poor cardiovascular outcome, independently of the cardiologic diagnosis and traditional risk factors.