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Curso de Atualização em Medicina Cardiovascular 2019
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NT-proBNP delta during an acute heart failure admission: a better predictor of 12-month mortality
Session:
CO7 - Insuficiência Cardíaca
Speaker:
Diana De Campos
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.3 Acute Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Diana Decampos; Carolina Saleiro; Rogerio Teixeira; João Lopes; Joana M. Ribeiro; Luís Puga; José Pedro Sousa; Ana Botelho; Carolina Lourenço; Lino Gonçalves
Abstract
<p>BACKGROUND: It has been established that N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) correlates with hemodynamics in patients with acute decompensated heart failure (ADHF). Moreover, the best cutoff of the delta NTproBNP during hospital stay to estimate prognosis still remains unknown.</p> <p>METHODS: A retrospective study was conducted focusing on consecutive patients who survived a hospitalization for ADHF in a single center coronary care intensive unit. All-cause mortality at 12 months was analyzed. Continuous variables were analyzed by Student <em>t</em>-test and categorical variables were compared via <em>X</em><sup>2</sup>test. Receiver operating characteristic (ROC) analysis comparison (Delong method) was used to assess the accuracy of the admission, discharge and delta (Δ) in NT-proBNP to estimate mortality. Patients were then stratified by the associated criterion calculated by ROC analysis. We subsequently performed a multivariate Cox regression model to test, among other variables, the verified cut points.</p> <p>RESULTS: A total of 213 patients were included (77.0% males and 70±13 years old) with a left ventricle ejection fraction of 35.2±13.4%. The 12-month mortality rate a was 36.6%. ROC curve analysis showed that ΔNT-proBNP had a better accuracy for 12-month mortality than single determination of NT-proBNP at admission (AUC Δ NT-proBNP 0.59 vs AUC NT-proBNP 0.51, pairwise comparison <em>P</em>=0.0312). According to the criterion, 124 (58.2%) had a change in NTproBNP > 2420pg/mL and 89 (41.8%) had a change in NT-proBNP ≤2420pg/mL during hospital stay. Univariate analysis identified age, sodium, use of inotropes or levosimendan and change in NT-proBNP as predictors of the endpoint. In the multivariate Cox analysis model all the variables continued to significantly impact the 12-month prognosis of ADHF patients. A change in NT-proBNP≤2420pg/mL had an HR of 2.089 (95%CI 1.318-3.309, <em>P</em>=0.002) for 12-month mortality. </p> <p>CONCLUSIONS: Among patients with recent ADHF, an in-hospital decrease in NTproBNP superior to 2420pg/mL was associated with lower 12-month mortality.</p>
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