NT-proANP and NT-proBNP as prognostic markers in patients with acute decompensated heart failure of different etiologies

• Published in: Clinical biochemistry 2013-08, Vol.46 (12), p.1013-1019
• Main Authors: Luers, Claus, Sutcliffe, Anke, Binder, Lutz, Irle, Sebastian, Pieske, Burkert
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Atrial Natriuretic Factor - blood; Biomarkers - blood; Decompensated heart failure; Female; Heart failure; Heart Failure - blood; Heart Failure - etiology; Heart Failure - mortality; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Natriuretic Peptide, Brain - blood; Natriuretic peptides; NT-proANP; NT-proBNP; Peptide Fragments - blood; Prognosis; Regression Analysis; ROC Curve; Stroke Volume; Survival Analysis
• ISSN: 0009-9120; 1873-2933
• DOI: 10.1016/j.clinbiochem.2013.03.014

Peak NT-proANP and NT-proBNP plasma levels after hospital admission may be of additional prognostic value in patients with acute decompensation of heart failure. The time-course of natriuretic plasma levels after hospital admission, and a possible influence of the underlying etiology on the time-course have not been sufficiently investigated. Natriuretic peptide plasma levels of 85 patients with decompensated heart failure from ischemic and non-ischemic origins were measured at baseline and at 12h after hospital admission. NT-proBNP plasma levels on admission were lower compared to 12-hour-plasma levels, whereas NT-proANP plasma levels on admission were higher compared to 12-hour-plasma levels. Twenty-six patients (31%) died within the first 30days. In patients who died within the first 30days after admission NT-proANP and NT-proBNP plasma levels on admission and 12h later were significantly higher compared to survivors. Irrespective of different etiologies NT-proANP on admission and NT-proBNP 12h after admission were highest and demonstrated superior impact with respect to the prediction of 30-day-mortality. NT-proANP and NT-proBNP are powerful markers of 30-day-mortality in patients with acute heart failure of ischemic and non-ischemic origins. With respect to the prediction of 30-day-mortality, NT-proBNP plasma levels at 12h after admission are comparable with NT-proANP plasma levels on admission. These data underline the fact that with regard to etiology-dependent hemodynamic changes and plasma half-time, the determination of peak plasma levels is of highest importance for the estimation of the impact of natriuretic peptides on the prognosis of patients with decompensated heart failure. •Natriuretic peptides are powerful markers of 30-day-mortality in acute heart failure.•Determination of peak plasma levels is necessary for best risk-prediction.•The magnitude of plasma levels depends on plasma-half-time.•Courses of plasma levels are dependent on etiology-dependent hemodynamic changes.