Prognostic impact of plasma brain natriuretic peptide for cardiac events in elderly patients with congestive heart failure

Background: Plasma brain natriuretic peptide (BNP) has been reported to be useful in determining the prognosis of patients with ischemic heart disease and cardiomyopathy. However, aging increases the level of plasma BNP; ther efore, the prognostic impact of plasma BNP in elderly patients with congest ive heart failure has not been fully established. Objective: We sought to d etermine whether plasma BNP could predict recurrent cardiac events in elder ly patients with congestive heart failure. Methods: Forty-eight consecutive elderly patients (>65 years old) were enrolled in the present study. All p atients were admitted with their first episode of congestive heart failure. Clinical characteristics, plasma BNP, left ventricular ejection fraction, and left ventricular mass index were compared between patients with and tho se without recurrent cardiac events. Results: During the follow-up period, twelve cardiac events were observed. The New York Heart Association functio nal class was significantly higher in patients with cardiac events than in those without (p < 0.05). The plasma BNP level in patients with cardiac eve nts was significantly higher than in those without (521.0 <plus/minus> 156. 0 vs. 126.8 +/- 20.1 pg/ml, p < 0.001), despite more frequent treatment wit h angiotensin-converting enzyme inhibitors (75 vs. 28%, p < 0.05). The left ventricular ejection fraction was significantly lower and the left ventric ular mass index higher in patients with cardiac events as compared with tho se without (38.1 +/- 5.0 vs. 49.2 +/- 2.4%, p < 0.05; 193.8 <plus/minus> 14 .3 vs. 132.6 +/- 7.8 g/m(2), p < 0.001, respectively). The plasma BNP was s elected as an independent factor associated with cardiac events besides New York Heart Association functional class, left ventricular ejection fractio n, and left ventricular mass index using multivariate Cox proportional-haza rds regression analysis (hazard ratio = 2.656, p < 0.05). The cardiac event rate was significantly higher in patients with a plasma BNP concentration >132 pg/ml using Kaplan-Meier analysis (p < 0.001). Moreover, the plasma BN P level correlated inversely with the length of time from hospital discharg e to a cardiac event (r = -0.575, p < 0.05). Conclusion: Measuring the plas ma BNP level before hospital discharge in elderly patients with congestive heart failure was more useful than other conventional examinations for pred icting the recurrence of cardiac events. Copyright (C) 2001 S. Karger AG, B asel.