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Prognostic Implications of Changes in Amino-Terminal Pro-B-Type Natriuretic Peptide in Acute Decompensated Heart Failure: Insights from ASCEND-HF.

J Card Fail. 2019 Apr 03;:

Authors: Grodin JL, Liebo MJ, Butler J, Metra M, Felker GM, Hernandez AF, Voors AA, McMurray JJ, Armstrong PW, O’Connor C, Starling RC, Troughton RW, Wilson Tang WH

Abstract
BACKGROUND: Amino terminal pro-B-type natriuretic peptide (NTproBNP) is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification.
METHODS: Baseline, 48-72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF.
RESULTS: The median NTproBNP at baseline was 5,773 (2,981-11,579) pg/ml; at 48-72 hours was 3,036 (1,191-6,479) pg/ml; and at 30 days was 2,914 (1,364-6,667) pg/ml. Absolute changes in NTproBNP by 48-72 hours were not associated with 30-day heart failure rehospitalization or mortality (P=0.065), relative changes in NTproBNP were nominally associated (P=0.046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48-72 hours and to 30 days were closely associated with 180-day mortality (P<0.02 for all) with increased discrimination in comparison to the multivariable models with baseline NTproBNP (P<0.05 for models with relative and absolute change at both time points).
CONCLUSIONS: Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.

PMID: 30953792 [PubMed – as supplied by publisher]

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