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Received on March 1, 2006
Accepted on May 24, 2006
Lipids, Lipoproteins, and Cardiovascular Risk Factors |
1 Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
2 Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy, and 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
* To whom correspondence should be addressed. E-mail: masson{at}marionegri.it.
Background: The B-type 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 or 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. Receiver-operator characteristic curves were almost superimposable for all-cause mortality (area under the curve (SD): 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.
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