Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions - 31/01/18
, Yasuyuki Shiraishi, MD, PhD d, Shun Kohsaka, MD, PhD d, Michikazu Nakai, PhD e, Kunihiro Nishimura, MD, PhD e, Takashi Kohno, MD, PhD d, Yuji Nagatomo, MD, PhD f, Yasuhide Asaumi, MD, PhD a, Ayumi Goda, MD, PhD g, Atsushi Mizuno, MD h, Satoshi Yasuda, MD, PhD a, Hisao Ogawa, MD, PhD a, Tsutomu Yoshikawa, MD, PhD f, Toshihisa Anzai, MD, PhD a, con behalf of the
Investigators for the WET-NaDEF Collaboration Project
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Abstract |
Plasma B-type natriuretic peptide (BNP) is an important prognostic marker in patients with acute heart failure (AHF). However, it is unclear which BNP parameter, on admission, at discharge, or change during hospitalization, has the highest predictive performance for long-term adverse outcomes, and whether its prognostic impact differs according to the new European heart failure (HF) phenotype classification by left ventricular ejection fraction: heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). We examined 1,792 patients with AHF consisting of 860 (48%) HFrEFs, 318 (18%) HFmrEFs, and 614 (34%) HFpEFs. Prognostic performance of each BNP parameter was assessed by the Harrell c-index. During a median follow-up of 664 days, 344 (19%) patients died. Discharge BNP had the highest c-index (0.69) for mortality among all BNP parameters (p <0.001). In multivariate Cox proportional hazard modeling, discharge BNP was associated with mortality in HFrEF, HFmrEF, and HFpEF patients with significant interaction (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.57 to 2.41; HR 1.76, 95% CI 1.10 to 2.82; HR 1.46, 95% CI 1.12 to 1.91, respectively; p = 0.011 for interaction). Moreover, the c-index of discharge BNP for mortality in HFrEF patients (0.72) was higher than that in HFmrEF patients (0.68) and HFpEF patients (0.65). Similar results were obtained for mortality or HF rehospitalization as alternative outcomes, except there was no statistically significant interaction among HF phenotypes. In conclusion, discharge BNP is a more reliable marker than other BNP parameters on long-term outcome prediction in patients with AHF, but its prognostic impact may be weakened in HFmrEF and HFpEF compared with HFrEF.
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| The WET-NaDEF collaboration project was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology (Japan Society for the Promotion of Science [JSPS KAKENHI]), in Tokyo, Japan, Grant 23591062 and 26461088 awarded to TY; a Japan Health Labour Sciences Research in Tokyo, Grant 14528506 awarded to TY; and the Sakakibara Clinical Research Grant for Promotion of Sciences, Japan, 2012, 2013, and 2014 awarded to TY; a grant from the Japan Agency for Medical Research and Development, in Tokyo, Grant 201439013C awarded to SK; a grant from the Japan Cardiovascular Research Foundation, in Bunkyo-Ku, Grant 24-4-2 awarded to TA; and a Grant-in-Aid for Young Scientists from JSPS KAKENHI, Grant 15K19402, awarded to TN. |
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| See page •• for disclosure information. |
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