Dynamic risk stratification using serial measurements of plasma concentrations of natriuretic peptides in patients with heart failure

Zhang, J., Pellicori, P. , Pan, D., Dierckx, R., Clark, A.L. and Cleland, J.G.F. (2018) Dynamic risk stratification using serial measurements of plasma concentrations of natriuretic peptides in patients with heart failure. International Journal of Cardiology, 269, pp. 196-200. (doi:10.1016/j.ijcard.2018.06.070) (PMID:30001941)

Zhang, J., Pellicori, P. , Pan, D., Dierckx, R., Clark, A.L. and Cleland, J.G.F. (2018) Dynamic risk stratification using serial measurements of plasma concentrations of natriuretic peptides in patients with heart failure. International Journal of Cardiology, 269, pp. 196-200. (doi:10.1016/j.ijcard.2018.06.070) (PMID:30001941)

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Abstract

Background: Prognostic models for patients with chronic heart failure are generally based on a single assessment but treatment is often given with the intention of changing risk; re- evaluation of risk is an important aspect of care. The prognostic value of serial measurements of natriuretic peptides for the assessment of changes in risk is uncertain. Aims: To evaluate the prognostic value of serial measurements of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) during follow-up of out-patients with chronic heart failure (CHF). Methods: Patients diagnosed with CHF between 2001 and 2014 at a single out-patient clinic serving a local community were included in this analysis. NT-proBNP was measured at the initial visit and serially during follow-up. Only patients who had one or more measurements of NT-proBNP after baseline, at 4, 12 and/or 24 months were included. Results: At baseline, amongst 1,998 patients enrolled, the median age was 73 (IQR: 64-79) years, 70% were men, 31% were in NYHA class III/IV, 58% had a reduced ejection fraction and 77% had NT-proBNP >400 pg/ml. Median follow-up was 4.8 (IQR 2.5-8.6) years. Serial measurements of NT-proBNP improved prediction of all-cause mortality at 3 years (c- statistic=0.71) compared with using baseline data only (c-statistic=0.67; p<0.001) but a model using only the most recent NT-proBNP had an even higher c-statistic (0.72; p<0.001). Similar results were obtained based on long-term prediction of mortality using all available follow-up data. Conclusions: Serial measurement of NT-proBNP in patients with CHF improves prediction of all-cause mortality. However, using the most recent value of NT-proBNP has similar predictive power as using serial measurements.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Zhang, J., Pellicori, P., Pan, D., Dierckx, R., Clark, A.L., and Cleland, J.G.F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:25 June 2018
Copyright Holders:Copyright © 2018 Elsevier B.V.
First Published:First published in International Journal of Cardiology 269: 196-200
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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