Value of proBNP1–108 testing for the risk stratification of patients with systolic heart failure

• ProBNP1–108, BNP and Nt-proBNP levels were measured in patients with systolic heart failure (HF).
• Their predictive value for long-term survival was assessed through an 8 years follow-up.
• ProBNP1–108 levels were markedly increased in patients with systolic HF.
• The highest proBNP levels were related to patients with the highest risk of CV death.

The study objectives were to determine the circulating levels of proBNP1–108, the precursor of B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP), in patients with systolic heart failure (HF) and to assess their prognosis value for cardiovascular (CV) death over a long-term follow-up. Seventy-three patients with systolic HF and 68 healthy volunteers were included. ProBNP1–108, BNP and NT-proBNP levels were measured with automated immunoassays and their predictive value for long-term survival was assessed through an 8 years follow-up. ProBNP1–108 levels were markedly increased in patients with systolic HF in comparison to healthy volunteers. In univariate proportional hazard model, survival was related to proBNP1–108, BNP, NT-proBNP, age, EF and glomerular filtration rate (eGFR). Kaplan–Meier survival curves according to proBNP tertiles diverged significantly, and the highest proBNP levels were related to patients with the highest risk of CV death. In a multivariate analysis including age, EF, proBNP1–108, BNP, NT-proBNP, and eGFR levels, NT-proBNP was the strongest predictor of long term CV death. Our study therefore demonstrated that high levels of proBNP1–108, measured with an assay with enhanced analytical specificity, are related to the long-term risk of cardiovascular death in systolic heart failure.