NT-proBNP provides incremental prognostic information in cardiac outpatients with and without echocardiographic findings

Abstract

Background: Outpatients frequently present with elevated natriuretic peptides in the absence of an obvious cardiac abnormality or with normal natriuretic peptides despite echocardiographic findings.

Hypothesis: We aimed to determine the prognostic value of N-terminal pro B-type natriuretic peptide (NTpBNP) in outpatients with normal and abnormal echocardiography.

Methods: A total of 433 cardiovascular outpatients were included. The prognostic value of NTpBNP in patients with normal and abnormal echocardiography during a 2-year follow-up was evaluated.

Results: Patients with abnormal echocardiography and elevated NTpBNP had a mortality rate of 8.7% and an overall event rate of 20.2% (composite end point of overall mortality, myocardial infarction, and hospitalization for heart failure), which was significantly higher than in patients with abnormal echocardiography and normal NTpBNP, in which no mortality (P=0.011) and no events were observed (P<0.001). In patients with a normal echocardiography, mortality was 1.5% and 1.8% for patients with normal and elevated NTpBNP, respectively (P=1.000). Composite event rate was 1.5% and 8.9% (P=0.093), respectively.

Conclusions: Patients with low NTpBNP have an excellent prognosis irrespective of echocardiographic findings. Therefore, determination of NTpBNP appears useful in assessing the clinical relevance of echocardiographic findings.

Figure 1

Event‐free survival in relation to N‐terminal pro B‐type natriuretic peptide (NTpBNP) and echocardiographic results (A), and in relation to NTpBNP and New York Heart Association (NYHA) class (B). Kaplan‐Meier curves are shown for patients with normal and abnormal echocardiography and normal and elevated NTpBNP (A), and for patients in NYHA class I and NYHA class >I and normal and elevated NTpBNP (B). P values indicate overall log‐rank comparison. Events are all‐cause mortality, myocardial infarction, and hospitalization for heart failure.