• Piotr Kubler, Ewa A Jankowska, Jacek Majda, Krzysztof Reczuch, Waldemar Banasiak, and Piotr Ponikowski.
• Cardiology Department, Military Hospital, Wroclaw, Poland.
• Int. J. Cardiol. 2008 Oct 13; 129 (3): 373-8.

BackgroundOptimal risk stratification in heart failure patients surviving an episode of acute decompensation has not yet been established. We investigated whether a lack of significant decrease in plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) during hospital stay can identify patients at high risk of poor outcome.MethodsWe studied 103 consecutive patients with acute heart failure (86 men, age: 64 + or - 13 years, LVEF: 28 + or - 8%). The primary end-point was all-cause mortality at 1-year follow-up.ResultsMedian plasma NT-proBNP on admission was 6116 pg/mL (upper/lower quartiles: 3575, 10,958) vs. 2930 pg/mL (1674, 5794) after clinical stabilization (7 + or - 3 days after admission). During the 1-year follow-up 29 (28%) patients died. A decrease in plasma NT-proBNP during clinical recovery (expressed as percentage of NT-proBNP on admission) predicted favorable outcome in the single predictor analysis (p<0.001) and multivariable analyses (p<0.001). Receiver operating characteristic curve analysis revealed that 65% was the cut-off value for NT-proBNP decrease having best prognostic accuracy for predicting death (sensitivity 90%, specificity 37%, AUC=0.65, 95% CI: 0.54-0.74). Kaplan-Meier analysis showed that 12-month survival was 92% (95% CI: 81-100%) for patients with > pr = 65% NT-proBNP decrease vs 66% (95% CI: 56-76%) in those with <65% NT-proBNP decrease (p=0.02).ConclusionsThe magnitude of plasma NT-proBNP decrease in patients with acute heart failure is helpful in discrimination of patients at high risk of death. Plasma NT-proBNP level monitoring is important for risk stratification in this group of patients.

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