Cor Vasa 2013, 55(4):e286-e292 | DOI: 10.1016/j.crvasa.2013.03.007

The importance of admission and discharge BNP assessment in patients hospitalized for acutely decompensated chronic systolic heart failure

Ondřej Ludka^a,e,*, Roman Štípal^a, Marta Šenkyříková^a, Viktor Musil^a, Jan Trna^b, Zbyněk Pozdíšek^c, Jiří Jarkovský^d, Ladislav Dušek^d, Jindřich Špinar^a,e

^a Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

^b Interní gastroenterologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

^c Kardiochirurgická klinika, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^d Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity, Brno, Česká republika

^e International Clinical Research Center, Brno, Česká republika

Introduction: The assessment of B-type natriuretic peptide (BNP) plasma levels is not only useful for the differential diagnosis of acute dyspnea, but also for the prognostic stratification of patients with heart failure. However, available studies that have addressed monitoring of hospitalized patients are burdened with significant limitations: 1) measurement of plasma BNP levels only at admission or at discharge, 2) lack of details regarding the cause of heart failure, 3) small sample size. Therefore, we conducted a prospective study of all patients presenting to our hospital with acutely decompensated chronic systolic heart failure.

Aim: To determine the importance of admission and discharge values of BNP and its changes during hospitalization for identification of patients with acutely decompensated chronic systolic heart failure at higher risk of unfavorable course of the disease.

Methods: A prospective monocentric study determining plasma BNP levels at admission and at discharge in patients hospitalized for acutely decompensated chronic systolic heart failure.
Patients: 130 consecutive patients, 77% men, mean age 70 years, body mass index (BMI) 27.8 kg/m2, etiology of chronic heart failure - 65.9% ischemic heart disease, 29.5% dilated cardiomyopathy, 4.6% others, signs and symptoms at admission - peripheral edema 58.9%, pulmonary rales 88.3%, orthopnea 53.1%, median of admission BNP 1 101 pg/ml, median of discharge BNP 650 pg/ml, median left ventricular ejection fraction 26.5%, average length of hospitalization 9 days.

Results: During the follow-up (mean 15 months) the total mortality rate reached almost 40% and the annual mortality of our cohort was 29%. The most common causes of death included progression of heart failure and acute coronary syndromes. To evaluate the long-term risk of mortality, we used time-dependent ROC curves for the definition of cut-off values of BNP at admission and discharge. The relationship of BNP levels and the survival of patients was assessed using the hazard ratio (HR) calculated by the Cox proportional hazards model. BNP at admission and at discharge with a cut-off value of 1 699 pg/ml and 434.5 pg/ml are significant prognostic factors for patients hospitalized for acutely decompensated chronic systolic heart failure with a HR 2.79 and 3.29, respectively. During the follow-up, more than half of patients required readmission to hospital. The most common reasons for rehospitalization were cardiovascular causes.

Conclusion: BNP levels at admission and at discharge are an important predictive factor of survival in patients with acutely decompensated chronic systolic heart failure.

Keywords: Admission and discharge BNP level; Heart failure; Prognosis

Received: December 7, 2012; Revised: March 11, 2013; Accepted: March 18, 2013; Published: August 1, 2013  Show citation