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Lipids, Lipoproteins, and Cardiovascular Risk Factors |
1 Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
2 Department of Medicine, New York Medical College, Valhalla, NY.
3 Cardiology Section, Veterans Affairs Medical Center, Minneapolis, MN.
4 Laboratorio di Endocrinologia, Ospedale "Luigi Sacco", Milan, Italy.
5 Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
6 Laboratory of Cardiovascular Endocrinology and Cell Biology, Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, Pisa, Italy.
7 Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy.
aAddress correspondence to this author at: Istituto di Ricerche Farmacologiche "Mario Negri", via Eritrea 62, 20157 Milan, Italy. Fax 39-023-320-0049; e-mail masson{at}marionegri.it.
Background: The B-type or brain natriuretic peptides (BNP) and the amino-terminal probrain natriuretic peptide (NT-proBNP) are good markers of prognosis and diagnosis in chronic heart failure (HF). It is unclear, however, whether differences in their biological characteristics modify their clinical correlates and prognostic performance in HF. This work aimed to provide a direct comparison of the prognostic value of BNP and NT-proBNP in patients with chronic and stable HF.
Methods: We measured BNP and NT-proBNP at baseline in 3916 patients enrolled in the Valsartan Heart Failure Trial. To identify the variables associated with both peptides, we conducted simple and multivariable linear regression analyses. We used Cox multivariable regression models to evaluate the independent prognostic value for all-cause mortality, mortality and morbidity, and hospitalization for HF. Prognostic performance was assessed by pairwise comparisons of the area under the curve of receiver-operator characteristic curves.
Results: NT-proBNP and BNP had similar relationships with age, left ventrical ejection fraction, and internal diameter and creatinine clearance. Either peptide ranked as the first independent predictor of outcome after adjustment for major confounding clinical characteristics. ROC curves were almost superimposable for all-cause mortality (area under the curve (SE): BNP 0.665 (0.011) vs NT-proBNP 0.679 (0.011); P = 0.0734), but NT-proBNP was superior to BNP for predicting mortality and morbidity (P = 0.032) or hospitalization for HF (P = 0.0143). Overall sensitivity and specificity ranged from 0.590 to 0.696.
Conclusions: The natriuretic peptides BNP and NT-proBNP showed subtle differences in their relation to clinical characteristics and prognostic performance in a large population of patients with chronic and stable HF. They were the most powerful independent markers of outcome in HF.
The following articles in journals at HighWire Press have cited this article:
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  S. Masson, R. Latini, I. S. Anand, S. Barlera, L. Angelici, T. Vago, G. Tognoni, J. N. Cohn, and for the Val-HeFT Investigators Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial) J. Am. Coll. Cardiol., September 16, 2008; 52(12): 997 - 1003. [Abstract] [Full Text] [PDF]
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A. M. Richards Serial Measurements of Plasma B-Type Natriuretic Peptides: What Do They Tell Us? J. Am. Coll. Cardiol., September 16, 2008; 52(12): 1004 - 1005. [Full Text] [PDF]
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 E. C H J Michielsen, J. A Bakker, R. R J V. Kimmenade, Y. M Pinto, and M. P V. Dieijen-Visser The diagnostic value of serum and urinary NT-proBNP for heart failure Ann Clin Biochem, July 1, 2008; 45(4): 389 - 394. [Abstract] [Full Text] [PDF]
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 S. Vickery, M. C. Webb, C. P. Price, R. I. John, N. A. Abbas, and E. J. Lamb Prognostic value of cardiac biomarkers for death in a non-dialysis chronic kidney disease population Nephrol. Dial. Transplant., June 18, 2008; (2008) gfn341v1. [Abstract] [Full Text] [PDF]
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 E. Braunwald Biomarkers in Heart Failure N. Engl. J. Med., May 15, 2008; 358(20): 2148 - 2159. [Full Text] [PDF]
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 R. Paniagua, D. Amato, S. Mujais, E. Vonesh, A. Ramos, R. Correa-Rotter, and W. H. Horl Predictive Value of Brain Natriuretic Peptides in Patients on Peritoneal Dialysis: Results from the ADEMEX Trial Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 407 - 415. [Abstract] [Full Text] [PDF]
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 M. Schou, F. Gustafsson, C. N. Kistorp, P. Corell, A. Kjaer, and P. R. Hildebrandt Effects of Body Mass Index and Age on N-Terminal Pro Brain Natriuretic Peptide Are Associated with Glomerular Filtration Rate in Chronic Heart Failure Patients Clin. Chem., November 1, 2007; 53(11): 1928 - 1935. [Abstract] [Full Text] [PDF]
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C. R. deFilippi, S. L. Seliger, S. Maynard, and R. H. Christenson Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality Clin. Chem., August 1, 2007; 53(8): 1511 - 1519. [Abstract] [Full Text] [PDF]
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T. Omland, M. S. Sabatine, K. A. Jablonski, M. M. Rice, J. Hsia, R. Wergeland, S. Landaas, J. L. Rouleau, M. J. Domanski, C. Hall, et al. Prognostic Value of B-Type Natriuretic Peptides in Patients With Stable Coronary Artery Disease: The PEACE Trial J. Am. Coll. Cardiol., July 17, 2007; 50(3): 205 - 214. [Abstract] [Full Text] [PDF]
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 T. Tsutamoto, T. Tanaka, H. Sakai, C. Ishikawa, M. Fujii, T. Yamamoto, and M. Horie Total and high molecular weight adiponectin, haemodynamics, and mortality in patients with chronic heart failure Eur. Heart J., July 2, 2007; 28(14): 1723 - 1730. [Abstract] [Full Text] [PDF]
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 B. Assmus, U. Fischer-Rasokat, J. Honold, F. H. Seeger, S. Fichtlscherer, T. Tonn, E. Seifried, V. Schachinger, S. Dimmeler, and A. M. Zeiher Transcoronary Transplantation of Functionally Competent BMCs Is Associated With a Decrease in Natriuretic Peptide Serum Levels and Improved Survival of Patients With Chronic Postinfarction Heart Failure: Results of the TOPCARE-CHD Registry Circ. Res., April 27, 2007; 100(8): 1234 - 1241. [Abstract] [Full Text] [PDF]
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