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Prognostic Implications of Changes in Amino-Terminal Pro-B-Type Natriuretic Peptide in Acute Decompensated Heart Failure: Insights From ASCEND-HF

Grodin, J. L., Liebo, M. J., Butler, J., Metra, M., Felker, G. M., Hernandez, A. F., Voors, A. A., McMurray, J. J., Armstrong, P. W., O'Connor, C., Starling, R. C., Troughton, R. W. & Tang, W. H. W., Sep-2019, In : JOURNAL OF CARDIAC FAILURE. 25, 9, p. 703-711 9 p.

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  • Prognostic Implications of Changes in Amino-Terminal Pro–B-Type Natriuretic Peptide in Acute Decompensated Heart Failure

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DOI

  • Justin L. Grodin
  • Max J. Liebo
  • Javed Butler
  • Marco Metra
  • G. Michael Felker
  • Adrian F. Hernandez
  • Adriaan A. Voors
  • John J. McMurray
  • Paul W. Armstrong
  • Christopher O'Connor
  • Randall C. Starling
  • Richard W. Troughton
  • W. H. Wilson Tang

Background: Amino-terminal pro-B-type natriuretic peptide (NTproBNP) is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification.

Methods: Baseline, 48-72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF.

Results: The median NTproBNP at baseline was 5773 (2981-11,579) pg/mL; at 48-72 hours was 3036 (1191-6479) pg/mL; and at 30 days was 2914 (1364-6667) pg/mL. Absolute changes in NTproBNP by 48-72 hours were not associated with 30-day heart failure rehospitalization or mortality (P = .065), relative changes in NTproBNP were nominally associated (P = .046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48-72 hours and to 30 days were closely associated with 180-day mortality (P <.02 for all) with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points).

Conclusions: Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.

Original languageEnglish
Pages (from-to)703-711
Number of pages9
JournalJOURNAL OF CARDIAC FAILURE
Volume25
Issue number9
Publication statusPublished - Sep-2019

    Keywords

  • Natriuretic peptide, nesiritide, acute heart failure, MEDICARE BENEFICIARIES, HOSPITAL DISCHARGE, ELDERLY-PATIENTS, TROPONIN-I, HIGH-RISK, ADMISSION, MORTALITY, REHOSPITALIZATION, READMISSION, MANAGEMENT

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