NT-proBNP/BNP ratio for prognostication in European Caucasian patients enrolled in a heart failure prevention programme

被引:10
作者
Sweeney, Claire [1 ,2 ]
Pharithi, Rebabonye B. [1 ,3 ]
Kerr, Brian [1 ,3 ]
Ryan, Cristin [2 ]
Ryan, Fiona [1 ]
Collins, Libhan [1 ]
Halley, Carmel [4 ]
Barrett, Matt [4 ]
Watson, Chris J. [1 ,3 ,5 ]
McDonald, Kenneth [1 ,3 ]
Ledwidge, Mark [1 ,2 ,3 ]
机构
[1] St Vincents Univ Healthcare Grp, STOP HF Unit, Dublin, Ireland
[2] Trinity Coll Dublin, Sch Pharm & Pharmaceut Sci, Dublin, Ireland
[3] Univ Coll Dublin, Sch Med, Dublin, Ireland
[4] St Vincents Univ Hosp Healthcare Grp, Heart Failure Unit, Dublin, Ireland
[5] Queens Univ Belfast, Wellcome Wolfson Inst Expt Med, Belfast, Antrim, North Ireland
来源
ESC HEART FAILURE | 2021年 / 8卷 / 06期
关键词
Heart failure prevention; Left ventricular dysfunction; Natriuretic peptides; NT-proBNP/BNP ratio; Screening; BRAIN NATRIURETIC PEPTIDE; LEFT ATRIAL VOLUME; CROSS-REACTIVITY; BNP; DYSFUNCTION; CLEARANCE; ASSAYS;
D O I
10.1002/ehf2.13576
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Guidelines support the role of B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) for risk stratification of patients in programmes to prevent heart failure (HF). Although biologically formed in a 1:1 ratio, the ratio of NT-proBNP to BNP exhibits wide inter-individual variability. A report on an Asian population suggests that molar NT-proBNP/BNP ratio is associated with incident HF. This study aims to determine whether routine, simultaneous evaluation of both BNP and NT-proBNP is warranted in a European, Caucasian population. Methods and Results We determined BNP and NT-proBNP levels for 782 Stage A/B HF patients in the STOP-HF programme. The clinical, echocardiographic, and biochemical associates of molar NT-proBNP/BNP ratio were analysed. The primary endpoint was the adjusted association of baseline molar NT-proBNP/BNP ratio with new-onset HF and/or progression of left ventricular dysfunction (LVD). We estimated the C-statistic, integrated discrimination improvement, and the category-free net reclassification improvement metric for the addition of molar NT-proBNP/BNP ratio to adjusted models. The median age was 66.6 years [interquartile range (IQR) 59.5-73.11, 371 (47.4%) were female, and median molar NT-proBNP/BNP ratio was 1.91 (IQR 1.37-2.93). Estimated glomerular filtration rate, systolic blood pressure, left ventricular mass index, and heart rate were associated with NT-proBNP/BNP ratio in a linear regression model (all P < 0.05). Over a median follow-up period of 5 years (IQR 3.4-6.8), 247 (31.5%) patients developed HF or progression of LVD. Log-transformed NT-proBNP/BNP ratio is inversely associated with HF and LVD risk when adjusted for age, gender, diabetes, hypertension, vascular disease, obesity, heart rate, number of years of follow-up, estimated glomerular filtration rate, and baseline NT-proBNP (odds ratio 0.71, 95% confidence interval 0.55-0.91; P = 0.008). However, molar NT-proBNP/BNP ratio did not increase the C-statistic (A -0.01) and net reclassification improvement (0.0035) for prediction of HF and LVD compared with NT-proBNP or BNP alone. Substitution of NT-proBNP for BNP in the multivariable model eliminated the association with HF and LVD risk. Conclusions This study characterized, for the first time in a Caucasian Stage A/B HF population, the relationship between NT-proBNP/BNP ratio and biological factors and demonstrated an inverse relationship with the future development of HF and LVD. However, this study does not support routine simultaneous BNP and NT-proBNP measurement in HF prevention programmes amongst European, Caucasian patients.
引用
收藏
页码:5081 / 5091
页数:11
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