Prognostic value of B-type natriuretic peptide in patients with chronic and advanced heart failure

Background: An increase in circulating B-type natriuretic peptide (BNP) is associated with a poor outcome in patients with acute heart failure. The primary aim of this study was to investigate the prognostic value of BNP levels in patients with chronic and advanced heart failure. Methods: Fifty patients with New York Heart Association functional classes III and IV were enrolled in the study. Their blood BNP levels at admission were measured and patients were on follow up for 12 +/- 2 months. Results: There was no significant correlation between BNP levels on admission and left ventricular ejection fraction (r = 0.12, P > 0.05). Twelve patients (24%) died during the follow up. BNP levels were lower in patients who died (501 +/- 72 vs 877 +/- 89 ng/L, P < 0.01). The logistic stepwise regression analysis showed that lower BNP level (< 520 ng/L) on admission was an independent predictor of cardiovascular mortality in these patients (odds ratio 1.21, 95% confidence interval 1.06-2.32, P < 0.01). Conclusion: We conclude that patients with chronic and advanced heart failure have a lower circulating BNP level than those who survive. The paradoxically low BNP level is an adverse prognostic marker in advanced heart failure.