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

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.