Incremental prognostic value of changes in B-type natriuretic peptide in heart failure

Roberto Latini, Serge Masson, Maylene Wong, Simona Barlera, Elisa Carretta, Lidia Staszewsky, Tarciso Vago, Aldo P. Maggioni, Inder S. Anand, Lip B. Tan, Gianni Tognoni, Jay N. Cohn

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105 Scopus citations


PURPOSE: B-type natriuretic peptide is one of the most sensitive and specific biohumoral markers of heart failure. We hypothesized that B-type natriuretic peptide changes during treatment of heart failure may provide independent information on disease progression and outcome in patients enrolled in the Val-HeFT trial. METHODS: Patients were divided into four groups according to concentrations of B-type natriuretic peptide at baseline versus 4 months (n = 3740) or 12 months (n = 3343), with respect to the baseline median (97 pg/mL): low→low (stable below median, 44%-46%), high→high (stable above median, 32%-37%), high→low (above to below median, 12%-14%), and low→high (below to above median, 6%-9%). Cox multivariate regression analysis was used to assess the risk of death and morbidity, with adjustment for baseline B-type natriuretic peptide concentrations. RESULTS: Patients who improved their B-type natriuretic peptide at 4 months (high→low) had a similar risk for mortality (hazard ratio = 1.191, 95% confidence interval [CI] 0.870-1.631, P =.2746) compared with the low→low patients. Conversely, patients who worsened in their B-type natriuretic peptide (low→high) had a risk for mortality (hazard ratio 2.578, CI, 1.861-3.571, P <.0001) higher than patients in the low→low group, and indistinguishable from the high→high group. Worsening of B-type natriuretic peptide (low→high) was associated with 0.03 cm/m2 increase in left ventricular end-diastolic diameter, whereas it decreased by 0.10 cm/m2 in high→low and low→low groups (P <.001). CONCLUSIONS: Changes in B-type natriuretic peptide over time with respect to a threshold value of 97 pg/mL convey an independent and additional prognostic value compared with a single determination of B-type natriuretic peptide in a large population of patients with chronic symptomatic heart failure and might be helpful in the management of these patients.

Original languageEnglish (US)
Pages (from-to)70.e23-70.e30
JournalAmerican Journal of Medicine
Issue number1
StatePublished - Jan 2006

Bibliographical note

Funding Information:
This study was supported by a grant from Novartis Pharma, Basel, Switzerland. Drs Latini, Maggioni, and Anand received honoraria for presentations; Drs Tognoni and Cohn received research support through consultation arrangements with Novartis Pharmaceuticals.


  • Brain natriuretic peptide
  • Heart failure
  • Prognosis
  • Trials


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