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N-terminal pro B-Type Natriuretic Peptide (Nt proBNP) and Prediction of Subsequent Heart Failure Events in Class A and B Heart Failure Patients
S106 Journal of Cardiac Failure Vol. 13 No. 6 Suppl. 2007 general population. Method: We included 3508 adult subjects (age; 40e69) of a community-based cohort from Korea Rural Genomic Cohort (KRGC) Study. Thorough biochemical and clinical data were recorded for all subjects. The samples for NT-proBNP of all participants were assessed. In order to determine reference values, subjects having factors known to influence NT-proBNP levels were excluded. Also, to verify NT-proBNP testing for screening for subjects at high risk of CHF, we evaluated the relationship the clinical characteristics. Results: The characteristics of cohort are described as below; males: 41.2%, mean age: 54.8 6 8.4 years. The distribution of risk factors for CHF are hypertension (25%), LVH by ECG (15%), hypercholestolemia (4.5%), smoking (32%), DM (10.9%), history of coronary heart disease (4.9%), history of CHF (0.9%) or with symptoms (6.1%), elevated serum Cr ($ 1.5, 3.7%), obesity (40%), respectively. The value of NT-proBNP of all subjects showed as below; mean 60.1 6 42.1, median 36.5 pg/ mL. Also, the value of NT-proBNP of reference subjects (not having risk factors, n 5 824) showed as below; mean 40.8, median 32.1, minimum 5.0, maximum 296.2 pg/mL. There were no significant differences according to sex, smoking, DM, hypertension and ECG-LVH. But, in patients with history of CHF (58.5 6 103.29 vs. 213.8 6 258.8), severe obesity (62.4 6 119.3 vs. 52.1 6 61.9), old age (O60, 48.4 vs.84.2 6 139.5 pg/mL), BNP level was higher (p ! 0.05). Also, according to risk factors in CHF, patient with more than 3 factors had higher BNP levels (risk 0: 40.8 6 34.0, 1-2: 57.4 6 93.2, $ 3: 85.0 6 152.9 pg/mL). NT-proBNP levels were related to age, BMI, urine albumin, serum Cr, and hs-CRP (p ! 0.05). Conclusions: We demonstrated the reference NT-proBNP value in Korean adult general population. The results of this study indicate that individuals with high NT-proBNP levels in the community have accumulating risk factors for CHF and related to the several risk factors.
111 N-terminal pro B-Type Natriuretic Peptide (Nt proBNP) and Prediction of Subsequent Heart Failure Events in Class A and B Heart Failure Patients Vikas Bhalla, Meenakshi Bhalla, Paul Clopton, Nancy Gardetto, Alan S. Maisel; 1 Cardiology, UCSD, VAMC UCSD, San Diego, CA Background: N-terminal pro B-Type natriuretic peptide (Nt proBNP) is a neurohormonal marker useful for diagnosis and prognosis. The objective of this study was to determine whether Nt proBNP levels provided a useful strategy that helps identify high risk class A and class B HF patients that are likely to develop cardiac related events or death. Methods: Patients undergoing routine outpatient echocardiography at the VA, San Diego were consented and evaluated with Nt proBNP testing. Patients were divided based on new ACC/AHA classification but the stage C & D were clumped as symptomatic. Patients were followed up to one year for HF-related adverse events (ED visits, hospital admissions and death). Results: 667 subjects were enrolled in the study; 97% males, 78% Caucasians. The mean Nt proBNP levels in 3 groups (n 5 120,163, 352) were 111, 198 and 364 pg/ml, p ! .01, the event rate was 12.5, 16.6 & 25% p ! .01. Univariate and subsequent multivariate analysis showed ntproBNP to be the strongest predictors of future HF-related adverse events in stages B & CþD AUC 5 .682 and .633 p ! .01 respectively and did not reach significance in stage A patients. In stage B patients the mean ntproBNP levels was 437 in the patients who had events and 170 in those without, and a ntproBNP ! 281 pg/ml had excellent negative predictive value (89%) in precluding future HF-related events. Conclusions: NtproBNP levels rise with the heart failure stage and add to the ability to both risk stratify and predict future clinical HF-related events in asymptomatic patients.
111 N-terminal pro B-Type Natriuretic Peptide (Nt proBNP) and Prediction of Subsequent Heart Failure Events in Class A and B Heart Failure Patients Vikas Bhalla, Meenakshi Bhalla, Paul Clopton, Nancy Gardetto, Alan S. Maisel; 1 Cardiology, UCSD, VAMC UCSD, San Diego, CA Background: N-terminal pro B-Type natriuretic peptide (Nt proBNP) is a neurohormonal marker useful for diagnosis and prognosis. The objective of this study was to determine whether Nt proBNP levels provided a useful strategy that helps identify high risk class A and class B HF patients that are likely to develop cardiac related events or death. Methods: Patients undergoing routine outpatient echocardiography at the VA, San Diego were consented and evaluated with Nt proBNP testing. Patients were divided based on new ACC/AHA classification but the stage C & D were clumped as symptomatic. Patients were followed up to one year for HF-related adverse events (ED visits, hospital admissions and death). Results: 667 subjects were enrolled in the study; 97% males, 78% Caucasians. The mean Nt proBNP levels in 3 groups (n 5 120,163, 352) were 111, 198 and 364 pg/ml, p ! .01, the event rate was 12.5, 16.6 & 25% p ! .01. Univariate and subsequent multivariate analysis showed ntproBNP to be the strongest predictors of future HF-related adverse events in stages B & CþD AUC 5 .682 and .633 p ! .01 respectively and did not reach significance in stage A patients. In stage B patients the mean ntproBNP levels was 437 in the patients who had events and 170 in those without, and a ntproBNP ! 281 pg/ml had excellent negative predictive value (89%) in precluding future HF-related events. Conclusions: NtproBNP levels rise with the heart failure stage and add to the ability to both risk stratify and predict future clinical HF-related events in asymptomatic patients.