Evaluation of NT-proBNP to predict outcomes in advanced heart failure

Guy Macgowan (1) , Dermot Neely (2) , Robert Peaston (2) , Neil Wrightson (3) , Gareth Parry (3)

1 Cardiology
2 Biochemistry
3 Cardiopulmonary Transplantation

Aims: To determine which factors predict outcomes in a group of patients with advanced heart failure, and in particular if NT-proBNP provides additional clinical and prognostic information to other haemodynamic and biochemical data. Methods and Results: 91 patients were studied who were being evaluated for heart transplantation, with 166 assessments. The patients had advanced heart failure as determined by median cardiac index of 2.0 L/min/m2, left ventricular end-diastolic diameter 7.0 mm, and levels of NT-proBNP of 2473 pg/mL. Median follow up time was 359 days. Clinicians were blinded to NT-proBNP levels. NT-proBNP significantly correlated with cardiac index (R=-0.44, P<0.001), right atrial pressure (R=0.40, P<0.001), pulmonary arterial wedge pressure (R=0.38, P<0.001) and albumin (R=-0.52, P<0.001), and total bilirubin with right atrial pressure (R=0.59, P<0.001). Cardiac index was the most important independent predictor of outcome (P=0.0001), though bilirubin (P=0.001), and NT-proBNP (P<0.05) were also significant. In patients with a 50% increase in NT-proBNP 64% had adverse outcomes, whereas those in whom levels were stable 22% had adverse outcomes (P<0.05). Conclusion: Cardiac index is the primary independent predictor of outcome in advanced heart failure when haemodynamic deterioration is evident. In situations where invasive haemodynamics are not available, total bilirubin (reflecting hepatic congestion), and NT-proBNP (related to haemodynamics) also provide important prognostic information.

Mots clés: Medicine

Guy Macgowan, Dermot Neely, Robert Peaston, Neil Wrightson, Gareth Parry. Evaluation of NT-proBNP to predict outcomes in advanced heart failure. International Journal of Clinical Practice, 2010, 64 (7), pp.892. ⟨10.1111/j.1742-1241.2010.02388.x⟩. ⟨hal-00552653⟩