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Prognostic Value of Urinary and Plasma C-Type Natriuretic Peptide in Acute Decompensated Heart Failure
Xiao Ma1, Yang Chen1, Shawn H Reginauld1
1Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Elevated urinary and plasma C-type natriuretic peptide (CNP) in acute decompensated heart failure (ADHF) indicates a higher risk of adverse outcomes. Measuring both CNP levels improves prediction of rehospitalization and death in ADHF patients.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- C-type natriuretic peptide (CNP) is a protective hormone with antiremodeling properties, synthesized in the kidney and endothelium.
- While CNP levels are elevated in various pathophysiological states, their specific regulation and prognostic significance in heart failure (HF) remain unclear.
- Understanding CNP's role is crucial for advancing HF management and risk stratification.
Purpose of the Study:
- To characterize urinary and plasma CNP levels in acute decompensated heart failure (ADHF).
- To define the relationship between CNP levels and clinical variables in ADHF.
- To determine if combined urinary and plasma CNP measurements enhance prognostic value in ADHF.
Main Methods:
- Urinary and plasma CNP were measured in 109 healthy subjects and 208 ADHF patients.
- Normal CNP cutoffs were established using the 95th percentile from healthy subjects.
- ADHF patients were stratified by CNP levels to assess clinical characteristics and adverse outcome risk.
Main Results:
- Urinary and plasma CNP were significantly elevated in ADHF patients and correlated with disease severity and NT-proBNP levels.
- No significant correlation was found between urinary and plasma CNP.
- Elevated levels of both urinary and plasma CNP independently predicted a higher risk of rehospitalization and/or death over 3 years.
- The addition of CNP measurements improved risk prediction models for adverse outcomes in ADHF.
Conclusions:
- Urinary and plasma CNP exhibit differential regulation in ADHF.
- Combined elevations in urinary and plasma CNP provide independent prognostic value for adverse outcomes in ADHF.
- These findings support the use of combined CNP measurements for enhanced risk stratification in ADHF.
Objectives:
This study sought to characterize urinary and plasma C-type natriuretic peptide (CNP) in acute decompensated heart failure (ADHF) to define their relationship with clinical variables and to determine whether urinary and plasma CNP together add prognostic value.
Background:
CNP is a protective hormone that is synthesized in the kidney and endothelium and possesses antiremodeling properties. Urinary and plasma CNP levels are elevated in pathophysiological conditions; however, their regulation and prognostic value in heart failure (HF) is unclear.
Methods:
Urinary and plasma CNP were measured in 109 healthy subjects and 208 patients with ADHF; the 95th percentile of CNP values from healthy subjects established the normal contemporary cutoffs. Patients with ADHF were stratified based on urinary and plasma CNP levels for clinical characterization and the assessment of risk for adverse outcomes.
Results:
There was no significant correlation between urinary and plasma CNP in both cohorts. Urinary and plasma CNP were significantly elevated in patients with ADHF, and both increased with disease severity and were positively correlated with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP). Of the patients with ADHF, 23% had elevations in both urinary and plasma CNP, whereas 24% had normal CNP levels. During a median follow-up of 3 years, patients with elevated urinary and plasma CNP had a significantly higher risk of rehospitalization and/or death (HR: 1.79; P = 0.03) and rehospitalization (HR: 2.16; P = 0.01) after adjusting for age, sex, left ventricular ejection fraction, renal function, and plasma NT-proBNP. The C-statistic and integrated discrimination analyses further supported that the addition of urinary and plasma CNP to established risk models improved the prediction of adverse outcomes in patients with ADHF.
Conclusions:
Urinary and plasma CNP are differentially regulated in ADHF, and elevations in both provided independent prognostic value for predicting adverse outcomes.
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