HEART FAILURE AND CARDIOMYOPATHY

Variability of NT-proBNP plasma and urine levels in patients with stable heart failure: a 2-year follow-up study

Raquel Cortés¹, Miguel Rivera¹, Antonio Salvador², Vicente Bertomeu³, Fernando García de Burgos⁴, Esther Roselló-Lletí¹, Manuel Portolés⁵, Rafael Payá⁶, Luis Martínez-Dolz², Vicente Climent⁷

¹ Cardiology Unit, Research Centre, Hospital Universitario La Fe, Valencia, Spain
² Cardiology Unit, Hospital Universitario La Fe, Valencia, Spain
³ Cardiology Unit, Hospital Universitario San Juan, Alicante, Spain
⁴ Cardiology Unit, Hospital General Universitario de Elche, Alicante, Spain
⁵ Cell Biology and Pathology Unit, Research Centre, Hospital Universitario La Fe, Valencia, Spain
⁶ Cardiology Unit, Hospital General, Valencia, Spain
⁷ Cardiology Unit, Hospital General Universitario, Alicante, Spain

Correspondence to:
Dr M Rivera Otero
Jose Maria Haro, 59, puerta 59, 46022 Valencia, Spain; rivera_jmi{at}gva.es

Objectives: To examine N-terminal pro-brain natriuretic peptide (NT-proBNP) variability in plasma and urine samples of patients with stable heart failure (HF) during a 24-month follow-up.

Design: Prospective study.

Setting: Teaching hospital based study.

Patients: 74 clinically and functionally stable patients (NYHA class 2±0.5) out of 114 patients diagnosed with HF were followed up, and NT-proBNP plasma and urine levels were measured at baseline, 12 and 24 months.

Results: Significant differences in mean urinary levels (p<0.01) were found during follow-up, but no changes were found in plasma. Bland–Altman plots showed few variations in plasma percentages in the three intervals (stage I–basal; stage II–stage I; stage II–basal) with a coefficient of reproducibility (CR) of 22%, 21% and 25%, respectively. Changes in NT-proBNP urinary levels had a CR of 7.1%, 6.8% and 9.4% at the three intervals, respectively. A good correlation was found between plasma and urinary levels of NT-proBNP (p<0.001) and between the different NT-proBNP plasma (p<0.001) and urine measurements (p<0.001).

Conclusions: NT-proBNP plasma and urine levels show good stability in a 24-month follow-up of patients with stable heart failure. Thus, assessment of urinary and plasma NT-proBNP concentrations may be a useful tool for monitoring patients with HF during follow-up. The results suggest that variations in peptide concentrations exceeding 22% in plasma and 7% in urine in a 12-month follow-up and 25% and 9% in a 24-month follow-up may indicate pathophysiological changes.

Abbreviations: CR, coefficient of reproducibility; E/A, flow velocity in early diastole and during atrial contraction ratio; EF, ejection fraction; HF, heart failure; NT-proBNP, N-terminal pro-brain natriuretic peptide

Keywords: natriuretic peptides; urine; plasma; stability; variability

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