A 5-year increase in NT-proBNP levels (≥223 pg/mL) was associated with a higher risk of subsequent heart failure or cardiovascular death compared to the lowest quartile (HR 3.8; 95% CI 2.0-7.3).
Cohort (n=635)
Do 5-year changes in NT-proBNP levels predict subsequent heart failure hospitalization or cardiovascular death in patients with stable coronary artery disease?
Longitudinal increases in NT-proBNP over 5 years strongly predict subsequent heart failure hospitalization or cardiovascular death in patients with stable CAD, independent of baseline levels.
Hazard Ratio: 3.8 (95% CI 2–7.3)
p-value: p=< 0.001
BACKGROUND: The N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) is a powerful predictor of adverse outcomes in patients with coronary artery disease (CAD). However, little is known regarding the prognostic significance of longitudinal changes in NT-proBNP levels. METHODS: We evaluated the ability of 5-year changes in NT-proBNP levels to predict subsequent heart failure (HF) hospitalization or cardiovascular (CV) death in 635 participants with stable CAD enrolled in the Heart and Soul Study. RESULTS: The median (IQR) 5-year change in NT-proBNP was 50 pg/mL (-5 to +222). During an average of 4.0 ± 1.4 years follow-up (i.e., 9 years from the baseline measurement), there were 67 events. Participants with 5-year changes in the highest quartile (≥ 223 pg/mL increase in NT-proBNP) had an almost 4-fold greater risk of subsequent HF or CV death than those in the lowest quartile of ≤-5 pg/mL (HR 3.8; 95% CI 2.0-7.3; p < 0.001). This association remained strong after adjustment for demographic variables, comorbidities, left ventricular mass index, systolic and diastolic function, and baseline and follow-up NT-proBNP levels (HR 3.9; 95% CI 1.1-13.4; p = 0.01). CONCLUSION: Changes in NT-proBNP levels at 5 years predict subsequent HF or CV death in patients with stable CAD, independent of other prognostic markers, including baseline and follow-up NT-proBNP levels. A stable NT-proBNP level predicts a low risk of subsequent events.
Mishra et al. (2017) conducted a cohort in stable coronary artery disease (n=635). 5-year increase in NT-proBNP levels (highest quartile, ≥ 223 pg/mL) vs. Lowest quartile of 5-year change in NT-proBNP (≤-5 pg/mL) was evaluated on Heart failure (HF) hospitalization or cardiovascular (CV) death (HR 3.8, 95% CI 2.0-7.3, p=< 0.001). A 5-year increase in NT-proBNP levels (≥223 pg/mL) was associated with a higher risk of subsequent heart failure or cardiovascular death compared to the lowest quartile (HR 3.8; 95% CI 2.0-7.3).