A direct comparison of the natriuretic peptides and their relationship to survival in chronic heart failure of a presumed non‐ischaemic origin
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AbstractThe natriuretic peptides have been validated as sensitive and specific markers of left ventricular dysfunction; brain natriuretic peptide (BNP), N‐terminal atrial natriuretic peptide (NT‐proANP) and N‐terminal brain natriuretic peptide (NT‐proBNP) elevations have been associated with New York Heart Association (NYHA) Class I–IV heart failure. We directly compared the association of each of these markers with 1‐year survival in 173 patients with chronic heart failure of a presumed nonischaemic origin entering the PRAISE‐2 Trial, a clinical study which assessed the therapeutic effect of Amlodipine in patients with NYHA Class III and IV heart failure and a left ventricular ejection fraction (LVEF) <30%. BNP, NT‐proBNP, and NT‐proANP levels were all correlated with 1‐year mortality by univariate Cox proportional hazards analyses. With respect to multivariate Cox proportional hazards regression models containing variables deemed significant in univariate analyses, NT‐proANP alone was identified as an independent predictor of 1‐year mortality when log‐transformed continuous covariates were utilized in the analysis. When the analysis was repeated using dichotomous covariates, NT‐proANP remained the most significant predictor of 1‐year mortality, followed by NT‐proBNP, NYHA classification and BNP. We conclude that all three natriuretic peptides are significant predictors of short‐term mortality in subjects with chronic congestive heart failure (CHF) of a presumed nonischaemic origin. Larger prospective studies are required to validate the clinical utility of NT‐proANP as a discriminating marker of short‐term survival, and to validate proposed cutoffs of approximately 2300 pmol/l for NT‐proANP, 1500 pg/ml for NT‐proBNP, and 50 pmol/l for BNP as prognostic indicators of adverse short‐term outcome.
