Pro-B-Type Natriuretic Peptide Levels in Acute Decompensated Heart Failure

ObjectivesThe present study sought to evaluate the clinical utility of pro-B-type natriuretic peptides (proBNP) in patients admitted with acute decompensated heart failure.BackgroundPlasma natriuretic peptides (BNP1–32, N-terminal [NT]-proBNP1–76) have been demonstrated to assist in the diagnosis of patients with heart failure. However, the precursor to these polypeptides (proBNP1–108) circulates in plasma and may interfere with the measurement of currently used biomarkers.MethodsPlasma natriuretic peptides were assessed in 164 individuals (99% men) hospitalized with decompensated heart failure. The B-type natriuretic peptide (BNP), NT-proBNP, and proBNP levels at hospital admission and discharge were compared with the incidence of cardiac death and all-cause mortality within 90 days post-discharge.ResultsPro-B-type natriuretic peptides demonstrated a high degree of correlation with both BNP (R = 0.924, p < 0.001) and NT-proBNP (R = 0.802, p < 0.001) at admission. Further characterization of proBNP demonstrated little variation with changes in age, body mass index, creatinine, or systolic dysfunction. All 3 plasma natriuretic peptides were significantly elevated at admission in patients suffering a cardiac death or all-cause mortality (p < 0.05). Receiver-operating characteristic curves demonstrated that admission and discharge NT-proBNP (area under the curve [AUC] 0.788 and AUC 0.834) had superior prognostic power for all-cause mortality when compared with BNP (AUC 0.644, p < 0.01 and AUC 0.709, p < 0.01) and proBNP (AUC 0.653, p < 0.01 and AUC 0.666, p < 0.01) at the same time points.ConclusionsAdmission values of all natriuretic peptides can be used to predict cardiac death and all-cause mortality. A preliminary comparison suggests that discharge values of NT-proBNP have the greatest diagnostic yield for predicting these end points. Further studies should explore the synergistic prognostic potential of all natriuretic peptides.