Lack of decrease in plasma N-terminal pro-brain natriuretic peptide identifies acute heart failure patients with very poor outcome Piotr Kubler, Ewa A. Jankowska ⁎ , Jacek Majda, Krzysztof Reczuch, Waldemar Banasiak, Piotr Ponikowski Cardiology Department, Military Hospital, Wroclaw, Poland Received 24 March 2007; accepted 7 July 2007 Available online 4 December 2007 Abstract Background: Optimal risk stratification in heart failure patients surviving an episode of acute decompensation has not yet been established. We investigated whether a lack of significant decrease in plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) during hospital stay can identify patients at high risk of poor outcome. Methods: We studied 103 consecutive patients with acute heart failure (86 men, age: 64±13 years, LVEF: 28±8%). The primary end-point was all-cause mortality at 1-year follow-up. Results: Median plasma NT-proBNP on admission was 6116 pg/mL (upper/lower quartiles: 3575, 10,958) vs. 2930 pg/mL (1674, 5794) after clinical stabilization (7±3 days after admission). During the 1-year follow-up 29 (28%) patients died. A decrease in plasma NT-proBNP during clinical recovery (expressed as percentage of NT-proBNP on admission) predicted favorable outcome in the single predictor analysis (p b 0.001) and multivariable analyses (p b 0.001). Receiver operating characteristic curve analysis revealed that 65% was the cut-off value for NT-proBNP decrease having best prognostic accuracy for predicting death (sensitivity 90%, specificity 37%, AUC=0.65, 95% CI: 0.54– 0.74). Kaplan–Meier analysis showed that 12-month survival was 92% (95% CI: 81–100%) for patients with ≥ 65% NT-proBNP decrease vs 66% (95% CI: 56–76%) in those with b 65% NT-proBNP decrease (p = 0.02). Conclusions: The magnitude of plasma NT-proBNP decrease in patients with acute heart failure is helpful in discrimination of patients at high risk of death. Plasma NT-proBNP level monitoring is important for risk stratification in this group of patients. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Decompensated heart failure; N-terminal pro-brain natriuretic peptide; Prognosis 1. Introduction Patients with heart failure (HF) who develop an episode of acute decompensation have high mortality and morbidity [1–4]. Optimal risk stratification in this population remains difficult, because traditional prognosticators with an established role in chronic HF may not be simply applicable [1–5]. Circulating levels of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have been documented to be useful for diagnosis of HF and also for clinical monitoring and risk stratification across the whole spectrum of the disease [6–12]. An episode of acute heart failure (AHF), characterized by hemodynamic deteri- oration and related neuroendocrine activation, results in an excessive production of BNP [13,14]. Therapy directed towards hemodynamic stabilization and left ventricle unloading may significantly decrease circulating levels of natriuretic peptides [12,15,16]. Until now, only few studies have examined usefulness of serial evaluation of BNP/NT-proBNP during hospital stay in patients with AHF for monitoring of response to therapy and prognostic assessment [17–20]. International Journal of Cardiology 129 (2008) 373 – 378 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Cardiology Department, Military Hospital, Weigla 5, 50-981 Wroclaw, Poland. Tel./fax: + 48 717660250. E-mail address: Ewa.Jankowska@antro.pan.wroc.pl (E.A. Jankowska). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.07.126