Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial)

Serge Masson, Roberto Latini, Inder S. Anand, Simona Barlera, Laura Angelici, Tarcisio Vago, Gianni Tognoni, Jay N. Cohn

Research output: Contribution to journalArticle

217 Citations (Scopus)

Abstract

Objectives: This study sought to evaluate the association between changes over time of N-terminal pro-brain natriuretic peptide (NT-proBNP) expressed in different ways and outcome in patients with stable and chronic heart failure (HF). Background: Although previous studies examined the prognostic value of repeated determinations of BNP in HF, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT-proBNP in a large population of ambulatory patients with chronic HF with sufficient follow-up time. Methods: The NT-proBNP was measured at randomization and after 4 months in 1,742 patients enrolled in the placebo arm of Val-HeFT (Valsartan Heart Failure Trial). Changes in NT-proBNP concentrations over 4 months were expressed as absolute change from baseline, percent relative changes, or categorical changes across a threshold value and related to subsequent mortality. Results: A single determination of NT-proBNP (area under the curve at 4 months: 0.702, 95% confidence interval [CI]: 0.669 to 0.735) showed a higher prognostic discrimination than continuous changes of concentrations, expressed either as absolute (0.592, 95% CI: 0.549 to 0.634) or relative changes (0.602, 95% CI: 0.566 to 0.639). A Cox proportional hazards model showed that stratification of patients into 4 categories according to NT-proBNP levels at 2 time points 4 months apart with respect to a threshold concentration provided prognostic information in patients with chronic HF beyond that of a single determination. Conclusions: Serial determinations of NT-proBNP concentration and classification into few categories of changes according to threshold levels may be a superior strategy for risk stratification of patients with chronic and stable HF.

Original languageEnglish (US)
Pages (from-to)997-1003
Number of pages7
JournalJournal of the American College of Cardiology
Volume52
Issue number12
DOIs
StatePublished - Sep 16 2008

Fingerprint

Valsartan
Brain Natriuretic Peptide
Heart Failure
Confidence Intervals
Random Allocation
Proportional Hazards Models
Area Under Curve

Keywords

  • heart failure
  • natriuretic peptide
  • prognosis

Cite this

Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial). / Masson, Serge; Latini, Roberto; Anand, Inder S.; Barlera, Simona; Angelici, Laura; Vago, Tarcisio; Tognoni, Gianni; Cohn, Jay N.

In: Journal of the American College of Cardiology, Vol. 52, No. 12, 16.09.2008, p. 997-1003.

Research output: Contribution to journalArticle

Masson, Serge ; Latini, Roberto ; Anand, Inder S. ; Barlera, Simona ; Angelici, Laura ; Vago, Tarcisio ; Tognoni, Gianni ; Cohn, Jay N. / Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial). In: Journal of the American College of Cardiology. 2008 ; Vol. 52, No. 12. pp. 997-1003.
@article{9b6bc40408434bebb45d0082a359f94b,
title = "Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial)",
abstract = "Objectives: This study sought to evaluate the association between changes over time of N-terminal pro-brain natriuretic peptide (NT-proBNP) expressed in different ways and outcome in patients with stable and chronic heart failure (HF). Background: Although previous studies examined the prognostic value of repeated determinations of BNP in HF, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT-proBNP in a large population of ambulatory patients with chronic HF with sufficient follow-up time. Methods: The NT-proBNP was measured at randomization and after 4 months in 1,742 patients enrolled in the placebo arm of Val-HeFT (Valsartan Heart Failure Trial). Changes in NT-proBNP concentrations over 4 months were expressed as absolute change from baseline, percent relative changes, or categorical changes across a threshold value and related to subsequent mortality. Results: A single determination of NT-proBNP (area under the curve at 4 months: 0.702, 95{\%} confidence interval [CI]: 0.669 to 0.735) showed a higher prognostic discrimination than continuous changes of concentrations, expressed either as absolute (0.592, 95{\%} CI: 0.549 to 0.634) or relative changes (0.602, 95{\%} CI: 0.566 to 0.639). A Cox proportional hazards model showed that stratification of patients into 4 categories according to NT-proBNP levels at 2 time points 4 months apart with respect to a threshold concentration provided prognostic information in patients with chronic HF beyond that of a single determination. Conclusions: Serial determinations of NT-proBNP concentration and classification into few categories of changes according to threshold levels may be a superior strategy for risk stratification of patients with chronic and stable HF.",
keywords = "heart failure, natriuretic peptide, prognosis",
author = "Serge Masson and Roberto Latini and Anand, {Inder S.} and Simona Barlera and Laura Angelici and Tarcisio Vago and Gianni Tognoni and Cohn, {Jay N.}",
year = "2008",
month = "9",
day = "16",
doi = "10.1016/j.jacc.2008.04.069",
language = "English (US)",
volume = "52",
pages = "997--1003",
journal = "Journal of the American College of Cardiology.",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "12",

}

TY - JOUR

T1 - Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial)

AU - Masson, Serge

AU - Latini, Roberto

AU - Anand, Inder S.

AU - Barlera, Simona

AU - Angelici, Laura

AU - Vago, Tarcisio

AU - Tognoni, Gianni

AU - Cohn, Jay N.

PY - 2008/9/16

Y1 - 2008/9/16

N2 - Objectives: This study sought to evaluate the association between changes over time of N-terminal pro-brain natriuretic peptide (NT-proBNP) expressed in different ways and outcome in patients with stable and chronic heart failure (HF). Background: Although previous studies examined the prognostic value of repeated determinations of BNP in HF, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT-proBNP in a large population of ambulatory patients with chronic HF with sufficient follow-up time. Methods: The NT-proBNP was measured at randomization and after 4 months in 1,742 patients enrolled in the placebo arm of Val-HeFT (Valsartan Heart Failure Trial). Changes in NT-proBNP concentrations over 4 months were expressed as absolute change from baseline, percent relative changes, or categorical changes across a threshold value and related to subsequent mortality. Results: A single determination of NT-proBNP (area under the curve at 4 months: 0.702, 95% confidence interval [CI]: 0.669 to 0.735) showed a higher prognostic discrimination than continuous changes of concentrations, expressed either as absolute (0.592, 95% CI: 0.549 to 0.634) or relative changes (0.602, 95% CI: 0.566 to 0.639). A Cox proportional hazards model showed that stratification of patients into 4 categories according to NT-proBNP levels at 2 time points 4 months apart with respect to a threshold concentration provided prognostic information in patients with chronic HF beyond that of a single determination. Conclusions: Serial determinations of NT-proBNP concentration and classification into few categories of changes according to threshold levels may be a superior strategy for risk stratification of patients with chronic and stable HF.

AB - Objectives: This study sought to evaluate the association between changes over time of N-terminal pro-brain natriuretic peptide (NT-proBNP) expressed in different ways and outcome in patients with stable and chronic heart failure (HF). Background: Although previous studies examined the prognostic value of repeated determinations of BNP in HF, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT-proBNP in a large population of ambulatory patients with chronic HF with sufficient follow-up time. Methods: The NT-proBNP was measured at randomization and after 4 months in 1,742 patients enrolled in the placebo arm of Val-HeFT (Valsartan Heart Failure Trial). Changes in NT-proBNP concentrations over 4 months were expressed as absolute change from baseline, percent relative changes, or categorical changes across a threshold value and related to subsequent mortality. Results: A single determination of NT-proBNP (area under the curve at 4 months: 0.702, 95% confidence interval [CI]: 0.669 to 0.735) showed a higher prognostic discrimination than continuous changes of concentrations, expressed either as absolute (0.592, 95% CI: 0.549 to 0.634) or relative changes (0.602, 95% CI: 0.566 to 0.639). A Cox proportional hazards model showed that stratification of patients into 4 categories according to NT-proBNP levels at 2 time points 4 months apart with respect to a threshold concentration provided prognostic information in patients with chronic HF beyond that of a single determination. Conclusions: Serial determinations of NT-proBNP concentration and classification into few categories of changes according to threshold levels may be a superior strategy for risk stratification of patients with chronic and stable HF.

KW - heart failure

KW - natriuretic peptide

KW - prognosis

UR - http://www.scopus.com/inward/record.url?scp=50949104678&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=50949104678&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2008.04.069

DO - 10.1016/j.jacc.2008.04.069

M3 - Article

VL - 52

SP - 997

EP - 1003

JO - Journal of the American College of Cardiology.

JF - Journal of the American College of Cardiology.

SN - 0735-1097

IS - 12

ER -