Utility of Amino-Terminal Pro–Brain Natriuretic Peptide Testing for Prediction of 1-Year Mortality in Patients With Dyspnea Treated in the Emergency Department

Harvard University, Cambridge, Massachusetts, United States
Archives of Internal Medicine (Impact Factor: 17.33). 02/2006; 166(3):315-20. DOI: 10.1001/archinte.166.3.315
Source: PubMed


Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is useful for diagnosis and triage of patients with dyspnea, but its role for predicting outcomes in such patients remains undefined.
A total of 599 breathless patients treated in the emergency department were prospectively enrolled, and a sample of blood was obtained for NT-proBNP measurements. After 1 year, the vital status of each patient was ascertained, and the association between NT-proBNP values at presentation and mortality was assessed.
At 1 year, 91 patients (15.2%) had died. Median NT-proBNP concentrations at presentation among decedents were significantly higher than those of survivors (3277 vs 299 pg/mL; P<.001). The optimal NT-proBNP cut point for predicting 1-year mortality was 986 pg/mL. In a multivariable model, an NT-proBNP concentration greater than 986 pg/mL at presentation was the single strongest predictor of death at 1 year (hazard ratio [HR], 2.88; 95% confidence interval, 1.64-5.06; P<.001), independent of a diagnosis of heart failure. Other factors associated with death included age (by decade; HR, 1.20), heart rate (by decile; HR, 1.13), urea nitrogen level (by decile; HR, 1.20), systolic blood pressure less than 100 mm Hg (HR, 1.94), heart murmur (HR, 1.92), and New York Heart Association classification (HR, 1.38 for each increase in class). The NT-proBNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0.76 for predicting mortality; the other significant covariates combined had an AUC of 0.80. The final model for predicting death, combining NT-proBNP with other covariates associated with mortality, had a superior AUC of 0.82.
In addition to assisting in emergency department diagnosis and triage, NT-proBNP concentrations at presentation are strongly predictive of 1-year mortality in dyspneic patients.

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    • "Nevertheless, sST2 seemed to have prognostic features: the combination of elevated NT-proBNP and low sST2 was observed in patients suffering from dyspnoea not related to acute HF onset[26]. Furthermore, a subgroup of patients with acute HF related symptoms showed an AUC of 0.80 (95% CI 0.75 to 0.84; p < 0.001) at ROC analyses regarding the relationship between sST2 and 1 year mortality[26], which was higher than the AUC value related to NT-proBNP for the same population (0.76, p < 0.001)[32]). Nevertheless, Kaplan-Meier curves showed further interesting information: the combination of sST2 to BNP and NT-proBNP measurements is able to increase the accuracy in detecting high risk dyspnoeic patients for acute HF onset.Socrates et al.outlined that the subgroup of patients with high sST2 levels and low levels of natriuretic peptides (both BNP/NT-proBNP) had increased mortality risk[29]. "
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    ABSTRACT: Cardiovascular diseases (CVD) are the major cause of death worldwide. The identification of markers able to detect the early stages of such diseases and/or their progression is fundamental in order to adopt the best actions in order to reduce the worsening of clinical condition. Brain natriuretic peptide (BNP) and NT-proBNP are the best known markers of heart failure (HF), while troponins ameliorated the diagnosis of acute and chronic coronary artery diseases. Nevertheless, many limitations reduce their accuracy. Physicians have tried to develop further detectable molecules in order to improve the detection of the early moments of CVD and prevent their development. Soluble ST2 (suppression of tumorigenicity 2) is a blood protein confirmed to act as a decoy receptor for interleukin-33. It seems to be markedly induced in mechanically overloaded cardiac myocytes. Thus, HF onset or worsening of a previous chronic HF status, myocardial infarct able to induce scars that make the myocardium unable to stretch well, etc, are all conditions that could be detected by measuring blood levels of soluble ST2. The aim of this review is to explore the possible role of ST2 derived-protein as an early marker of cardiovascular diseases, above all in heart failure and ischemic heart diseases.
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    ABSTRACT: Natriuretic peptides, BNP and NT-proBNP, are increased in patients who have high myocardial wall tension. They have been exten- sively used to diagnose heart failure in patients presenting with dyspnoea. BNP and NT-proBNP serum levels are influenced by variables such as age, gender, body mass index and renal func- tion. More recently, their elevation in acute coronary syndromes, stable coronary heart disease, chronic obstructive lung disease, pulmonary hypertension and sepsis has been investigated. We review the diagnostic and prognostic value of circulating natriuretic peptides in the assessment of several medical diseases.
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