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N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart

R S Gardner1, F Ozalp, A J Murday

  • 1The Scottish Cardiopulmonary Transplant Unit, Glasgow Royal Infirmary, Glasgow, UK. rsgardner@doctors.org.uk

European Heart Journal
|October 3, 2003
PubMed

Insights

N-terminal pro-brain natriuretic peptide (NT-proBNP) effectively predicts mortality risk in advanced heart failure patients awaiting cardiac transplantation. This biomarker outperforms traditional markers like left ventricular ejection fraction (LVEF) and peak oxygen uptake (VO2).

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Transplantation Medicine

Background:

  • Cardiac transplantation (CTx) patient selection relies on clinical assessment and markers like left ventricular ejection fraction (LVEF), peak oxygen uptake (VO2), and heart failure survival score (HFSS).
  • Brain natriuretic peptide (BNP) is a known prognostic marker in mild to moderate chronic heart failure (CHF).
  • The prognostic value of NT-proBNP in advanced CHF and its comparison to existing markers for CTx selection remain unclear.

Purpose of the Study:

  • To evaluate the prognostic capability of NT-proBNP in patients with advanced CHF.
  • To compare the predictive performance of NT-proBNP against LVEF, peak VO2, and HFSS in this patient cohort.

Main Methods:

  • Prospective study of 142 consecutive patients with advanced CHF referred for CTx consideration.
  • Plasma NT-proBNP levels were measured, and patients were followed for a median of 374 days.
  • Primary endpoint: all-cause mortality; Secondary endpoint: all-cause mortality or urgent CTx.

Main Results:

  • Twenty patients (14.1%) experienced all-cause mortality, and 24 (16.9%) reached the combined endpoint.
  • Elevated NT-proBNP levels (above median) were the sole independent predictor of all-cause mortality and the combined endpoint.
  • LVEF, VO2, and HFSS did not independently predict mortality or the need for urgent cardiac transplantation.

Conclusions:

  • A single NT-proBNP measurement can identify high-risk patients in advanced CHF.
  • NT-proBNP demonstrates superior prognostic ability compared to LVEF, VO2, and HFSS in this population.
  • NT-proBNP is a valuable tool for risk stratification in advanced heart failure patients considered for transplantation.
Abstract

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