Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure

Objectives Using a prospective study design, we assessed the value of brain natriuretic peptide (BNP) to identify patients with heart failure who have an increased risk of deterioration of their functional status. Furthermore , we examined the relationship between BNP and various clinical characteris tics incorporated into an established survival model used for risk stratifi cation. Background Prediction of the clinical course is a crucial part of the decis ion-making process about the adequate treatment strategy, for patients with advanced congestive heart failure (CHF). Although laborious, multivariable indexes have been established for risk stratification, simple plasma BNP m easurements may be as useful as prognostic indicators. Methods In 78 patients referred to our heart failure clinic, plasma BNP lev els were compared with the results of a multivariable prognostic model. To assess the prognostic power of BNP, the clinical course of this cohort was monitored for a median follow-up period of 398 days. Results At study entry, plasma BNP and the heart failure survival score (HF SS) showed a significant correlation (r = -0.706). During follow-up, Kaplan -Meier estimates of freedom from clinical events differed significantly, fo r patients above and below the 75th percentile concentrations of plasma BNP (p<0.0001). Changes in plasma BNP were significantly related to changes in limitations of physical activity, as demonstrated by logistic regression a nalysis (chi-square statistic = 24.9, p<0.0001). Proportional hazards analy sis confirmed BNP as a powerful predictor of functional status deterioratio n (p<0.0001). This prognostic information was as powerful as that derived f rom the multivariable HFSS. Conclusions Measurement of plasma BNP concentrations might provide a useful and cost-effective screening toot that helps reduce the need and frequency , for more expensive cardiac tests. (J Am Coll Cardiol 2001;38:1934-41) (C) 2001 by the American College of Cardiology.