NT-proBNP in heart failure: are numbers really that important?
P Rodriguez Montes, A Fraile Sanz, N Gil Mancebo, S Humanes Ybanez, M De La Serna Real De Asua, M Gutierrez Munoz, A Vilchez Alcocer, E Parrales Fernandez, R Mata Caballero, J A Perea Egido, B Izquierdo Coronel, M V Garcia Lopez, J J Alonso MartinAbstract
Introduction
N-terminal prohormone of BNP (NT-proBNP) is a natriuretic peptide with a key role in the diagnosis, risk stratification and prognosis of heart failure (HF). Several observational studies and some systematic reviews have demonstrated that a ≥30% reduction of NT-proBNP after HF hospitalization decreases mortality and HF readmissions, as well as guiding the response to HF therapies. However, some clinical trials go against this previous evidence, indicating that achieving this ≥30% decrease doesn’t improve prognosis.
Purpose
Given that the present evidence about this topic is contradictory, this study aims to contribute to providing evidence on what a ≥30% reduction in the levels of NT-proBNP means in patients with HF. We analysed the factors and characteristics associated with that decrease at discharge in a cohort of patients hospitalized for HF in our hospital, as well as providing an insight as to if this shift in the levels is associated with better prognosis.
Methods
This is a prospective, observational and analytical study including all consecutive patients hospitalized for HF at the Cardiology Ward in our hospital in whom the levels of NT-proBNP were measured. Patients were divided into 2 groups, depending on wether they showed a ≥30% or a <30% decrease in NT-proBNP levels in the first visit after discharge, compared to admission. The median follow up was 9 [4-18] months.
Results
Our sample was composed of 446 patients. There were no significant differences in NT-proBNP reduction associated with sex, cardiovascular risk factors, atrial fibrillation, flutter, right or left-sided HF, low cardiac output or diuretic resistance. Factors like older age, chronic kidney disease (CKD), amyloidosis and valvular heart disease (more specifically the presence of significant aortic stenosis) were determinants of a lower decrease in NT-proBNP. On the other hand, this biomarker significantly decreased ≥30% in patients with tachycardia-induced cardiomyopathy. There also was a significant difference in the treatment at discharge, as patients on betablockers, mineralocorticoid receptor antagonists (MRA), sacubitril/valsartan and iSGLT2 achieved a higher reduction in NT-proBNP, while patients without these drugs didn’t reach the 30% cutoff value of NT-proBNP decrease. As to follow up, we found an increased risk of mortality in the <30% reduction group (HR 0.52, CI95% 0.34-0.7), with no significant differences as to HF readmissions between both groups (HR 0.82, CI95% 0.64-1.00).
Conclusions
Several studies have stablished a 30% decrease in NT-proBNP during hospitalization as a cutoff value associated with better prognosis in HF. In our cohort some factors associated with this ≥30% reduction were betablockers, MRA, sacubitril/valsartan and iSGLT2, while the presence of CKD, amyloidosis or aortic stenosis associated a <30% decrease in NT-proBNP. Patients with a ≥30% reduction associated better prognosis, exhibiting a lower risk of death.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.