LVEF 25 6 1.4%) hospitalized for decompensated chronic heart failure who received clinically-indicated nesiritide infusions. Blood samples were drawn before ...
The 12th Annual Scientific Meeting
HFSA
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LVEF 25 6 1.4%) hospitalized for decompensated chronic heart failure who received clinically-indicated nesiritide infusions. Blood samples were drawn before infusion, at 6 and 24 hours during infusion, and at 6 hours post-infusion and assayed for the novel biomarkers, and also for BNP and NT-proBNP. Results: All biomarkers were markedly elevated at baseline. Copeptin, NT-proBNP and MR-proANP demonstrated reductions in levels in response to nesiritide therapy; these reductions, however, were generally #20% from baseline. Copeptin and MR-proANP levels were higher and BNP and NT-proBNP levels were lower in post-hospital non-survivors vs. survivors. Higher copeptin and lower BNP and NT-proBNP levels were associated by proportional hazards analysis with an increased risk of post-hospital mortality (p 5 0.04). No additive predictive value could be demonstrated by conjoint use of biomarkers. Conclusions: MR-proANP and the inflammatory biomarkers pro-calcitonin and neopterin, while elevated in this cohort of patients with severe HF, seem to add little additional information for risk assessment and response to therapy. In contrast, copeptin appears to have substantial potential to assist in establishing prognosis and the follow-up of the response therapy in patients with end-stage HF even when BNP and NT-proBNP provide seemingly paradoxical information.
proBNP remained a predictor of mortality after adjustment for diagnosis and clinical characteristics.
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Conclusions: At one month, a decrease in NT-proBNP and symptom improvement are only weakly correlated. However, a decrease in NT-proBNP level in acute dyspnea patients is a powerful prognosticator independent of symptom change and initial diagnosis. Follow-up NT-proBNP levels should be considered in all patients with dyspnea irrespective of symptoms.
Prognostic Utility of B-Type Natriuretic Peptide Assessment in Stable Low-Risk Outpatients with Non-Ischemic Cardiomyopathy after Decompensated Heart Failure Mototsugu Nishii, Takayuki Inomata, Tohru Izumi; Angio-Cardiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan Objective: We investigated the clinical utility of B-type natriuretic peptide (BNP) assay in stable outpatients with non-ischemic dilated cardiomyopathy (NICM) after decompensated heart failure (HF). Background: Patients with NICM admitted for decompensated HF frequently experience sudden death or re-decompensation after hospital discharge. The prognostic value of BNP during hospitalization has been demonstrated. However, clinical utility of BNP in stable outpatient setting has been poorly investigated. Methods: Eighty-three NICM outpatients who were clinically stable in New York Heart Association functional class 1e2 for 6 months after discharge for decompensated HF were enrolled, and then followed for an additional 18 months. The main end-point was first readmission for decompensated HF or death. BNP levels were measured at 3-month intervals from discharge to enrollment, and echocardiographic dimensions at discharge and enrollment. Results: Mean discharge BNP level was 210 6 148 pg/ml. Twenty-eight patients were readmitted for decompensated HF or suddenly died on a median time of 11 months from the time of discharge. Among various variables including BNP measurements, clinical parameters and echocardiographic dimensions, a six month post-discharge BNP of O190 pg/ml was most closely associated with combined event in the Cox proportional hazards model (Hazard ratio: 2.29; 95% confidence interval: 1.42e3.56; P 5 0.0005), and had the best discriminatory power (area under the receiver operating characteristic curve: 0.91, sensitivity: 96%; specificity: 76%). Conclusions: Even in stable low-risk outpatients with NICM at 6 months after hospital discharge for decompensated HF, BNP assessment predicts a long-term risk of re-decompensation.
114 Thirty-Day Follow-Up NT-proBNP Levels after Emergency Department Visit for Acute Dyspnea: Association with Symptoms and Prediction of Survival Keyur B. Shah1, Willem K. Kop1, Robert H. Christenson2, Deborah B. Diercks3, Dick Kuo4, Sue Henderson1, Karen Hanson4, R. de Christopher Filippi1; 1Cardiology, University of Maryland, Baltimore, MD; 2Pathology, University of Maryland, Baltimore, MD; 3Emergency Medicine, University of California Davis, Sacramento, CA; 4Emergency Medicine, University of Maryland, Baltimore, MD Background: NT-proBNP levels in patients (pts) with acute dyspnea identify cardiac dyspnea and predict mortality. There are limited data for outpatient follow-up NT-proBNP levels after emergency department (ED) presentation. We studied the association of the change in NT-proBNP to symptoms, as determined by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and survival. Methods: In a prospective 5-center study, 412 pts who presented to the ED with dyspnea completed the MLHFQ and had NT-proBNP levels measured. 265 pts (mean age 58 6 14 yrs, 41% female) repeated both at 1-month and were followed for a total of one year. A significant change in NT-proBNP was defined as $30% from the ED level. The association of a change in NT-proBNP levels with symptoms (MLHFQ) and survival were assessed. Results: For the 256/412 who completed 1-month follow-up, median NT-proBNP concentrations were 328 pg/mL (IQR 36e2372) and the ejection fraction was 47%616. Forty-three percent had a $30% decrease in their NT-proBNP level. These pts had a higher prevalence of acute heart failure presentation (52% vs 27%, p 5 0.001). The change in NTproBNP level only weakly correlated with the change in the physical component of the MLHFQ (r 5 0.177, p 5 0.009). A $30% decrease in NT-proBNP (HR: 0.21 [95%CI: 0.06e0.71]), but not the change in the total or physical component of the MLHFQ score, was associated with improved survival. A decrease in NT-
115 Admissional and Discharge B-Type Natriuretic Peptide as Predictors of SixMonth Cardiac Events in Patients Hospitalized for Decompensated Heart Failure Humberto Villacorta1, Carlos C. Pereira1, Jacqueline Miranda1, Fernanda Amador1, Alvaro Pontes1, Plinio Resende1, Joao Petriz1, Denilson Albuquerque1; 1 Cardiology, Rede D’Or de Hospitais, Rio de Janeiro, RJ, Brazil Objectives: To determine the prognostic value of admissional and discharge B-type natriuretic peptide (BNP) in patients (pts) admitted with acute decompensated heart failure (ADHF). Methods: From January through December 2007, 84 pts admitted in three hospitals with ADHF who had admissional and discharge BNP determined were included. Mean age was 72.3 6 12.4 years and 55 (65%) were male. Mean ejection fraction was 41.7 6 15%. Sixty six (78.5%) pts had a previous history of heart failure. We assessed the role of admissional BNP in predicting in-hospital outcomes (mortality, need of mechanical ventilation, use of inotropes, and hospital length of stay over 7 days) and the value of admissional and discharge BNP in predicting six-month cardiac events (cardiovascular mortality and heart failure readmission). Results: BNP levels fell with treatment from admission to discharge (563 [236e976] to 320 [262e384]; p 5 0.28). Admissional BNP was an independent predictor of in-hospital events, but not of six-month events. Median discharge BNP in pts with and without six-month events was 520 (380e896) vs 264 (186e360), p 5 0.03. Six-month event rate in pts with discharge BNP O320 vs #320 was 55.2% vs 32.6%, p 5 0.036. Independent predictors of six-month events were discharge BNP (p 5 0.01), BUN (p 5 0.02) and systolic blood pressure (p 5 0.04). Conclusion: Discharge BNP, but not admissional BNP, is an independent predictor of six-month cardiac events in pts admitted for ADHF. Admissional BNP, however, is a good predictor of in-hospital outcomes.
116 Comparison of a Point-of-Care Method To Measure BNP Levels with a Standard Lab-Based Instrument in Patients with Congestive Heart Failure Kevin Jiang1, Kevin S. Shah1, Garrett J. Terracciano1, Sneha Bhamre1, Emanuela Pentova1, Robert L. Fitzgerald1, Alan S. Maisel1; 1Cardiology, University of California, San Diego, Veterans Affairs Medical Center, San Diego, CA Introduction: Current turnaround time for laboratory assessment of BNP is approximately 60 minutes. Decreasing this turnaround time will help physicians more rapidly identify patients with HF and lead to shortened times to treatment initiation. Currently there is no handheld point-of-care system in place for BNP that can be used without sacrificing precision and accuracy. Objective: Evaluate the analytical performance of the Abbott i-STAT analyzer, a handheld point-of-care system, in measuring B-type Natriuretic Peptide (BNP) against a lab-based system, the Abbott Architect ie2000SR. Methods: 164 samples were collected: 53 from the ED, 60 from the inpatient wards, and 51 from heart failure outpatient clinics. Inclusion criterion was a diagnosis of HF or ED presentation with shortness of breath. Patients on dialysis or under the age of 18 were excluded. Blood samples were centrifuged and the plasma isolated and frozen at e70F within 4 hours of being drawn. Samples were run in batches but simultaneously on the i-STAT and Architect. Linear regression and bias difference analyses were run to evaluate the accuracy of the i-STAT system.
