Acute systolic heart failure with normal admission BNP: clinical features and outcomes.

Pubmed ID: 28094130

Journal: International journal of cardiology

Publication Date: April 1, 2017

Affiliation: Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.

MeSH Terms: Humans, Male, Female, United States, Middle Aged, Disease Progression, Prognosis, Follow-Up Studies, Morbidity, Survival Rate, Retrospective Studies, Stroke Volume, Hospital Mortality, Time Factors, Ventricular Function, Left, Acute Disease, Patient Readmission, Natriuretic Peptide, Brain, Heart Failure, Systolic, Patient Admission, Biomarkers

Authors: Guglin M, Omar HR

Cite As: Omar HR, Guglin M. Acute systolic heart failure with normal admission BNP: clinical features and outcomes. Int J Cardiol 2017 Apr 1;232:324-329. Epub 2016 Dec 20.

Studies:

Abstract

INTRODUCTION: The characteristics and outcomes of patients hospitalized with acute systolic heart failure (HF) and normal admission B-type natriuretic peptide (BNP) has not been previously explored. METHODS: Using the ESCAPE trial data, we compared patients with acute HF and left ventricular ejection fraction (LVEF) ≤30% who have either normal or elevated BNP on the day of hospitalization. The study endpoints were 30-day and 6-month mortality, all-cause rehospitalization and rehospitalization for HF. RESULTS: Among 347 patients with acute systolic HF, 43 had normal (mean 50.6pg/mL) and 304 had elevated admission BNP (mean 1144pg/mL). Compared with patients with elevated BNP, those with normal admission BNP were younger (51.5 vs. 56.8years, P=0.01), with higher body mass index (33.6 vs. 28.7kg/m<sup>2</sup>, P&lt;0.0001), lower frequency of ischemic etiology for heart disease (20.9% vs. 51.7%, P&lt;0.001), lower blood urea nitrogen (29.1 vs. 36.3mg/dL, P=0.005) and creatinine (1.34 vs. 1.52mg/dL, P=0.038) levels, higher LVEF (25.5% vs. 19.1%, P=0.018), higher cardiac index (2.34 vs. 1.96, P=0.013), and better diastolic function evident by lower E/A ratio (1.73 vs. 2.67, P=0.001) and longer deceleration of E velocity (166 vs. 141ms, P=0.028). There was no difference between patients with normal or elevated admission BNP with regards to the degree of congestion. There were no differences between both groups in post-discharge hard endpoints such as 30-day (P=0.101) and 6-month (P=0.143) mortality, rehospitalization for any cause (P=0.992) or for HF (P=0.763). CONCLUSION: Patients hospitalized with acute systolic HF and normal admission BNP had no significant differences in the degree of congestion and post-discharge outcomes compared with those with elevated BNP. A normal BNP in this instance was not valuable for diagnostic or prognostic purposes.