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Heart failure and cardiomyopathy
The prognostic value of individual NT-proBNP values in chronic heart failure does not change with advancing age
  1. L Frankenstein1,
  2. A L Clark2,
  3. K Goode2,
  4. L Ingle3,
  5. A Remppis1,
  6. D Schellberg1,
  7. F Grabs1,
  8. M Nelles1,
  9. J G F Cleland2,
  10. H A Katus1,
  11. C Zugck1
  1. 1
    University of Heidelberg, Heidelberg, Germany
  2. 2
    Department of Academic Cardiology, University of Hull, Kingston-upon-Hull, UK
  3. 3
    Carnegie Research Institute, Leeds Metropolitan University, Leeds, UK
  1. Dr L Frankenstein, Department of Cardiology, Angiology, Pulmonology, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany; Lutz.Frankenstein{at}med.uni-heidelberg.de

Abstract

Background: It is unclear whether age-related increases in N-terminal pro-brain natriuretic peptide (NT-proBNP) represent a normal physiological process—possibly affecting the prognostic power—of NT-proBNP—or reflect age-related subclinical pathological changes.

Objective: To determine the effect of age on the short-term prognostic value of NT-proBNP in patients with chronic heart failure (CHF).

Design: Prospective observational study with inclusion and matching of consecutive patients aged >65 years (mean (SD) 73.1 (6.0) years) to patients <65 years (53.7 (8.6) years) with respect to NT-proBNP, New York Heart Association stage, sex and aetiology of CHF (final n = 443).

Setting: University hospital outpatient departments in the UK and Germany.

Patients: Chronic stable heart failure due to systolic left ventricular dysfunction.

Intervention: None.

Outcome measure: All-cause mortality.

Results: In both age groups, NT-proBNP was a significant univariate predictor of mortality, and independent of age, sex and other established risk markers. The prognostic information given by NT-proBNP was comparable between the two groups, as reflected by the 1-year mortality of 9% in both groups. The prognostic accuracy of NT-proBNP as judged by the area under the receiver operating characteristics curve for the prediction of 1-year mortality was comparable for elderly and younger patients (0.67 vs 0.71; p = 0.09).

Conclusion: NT-proBNP reflects disease severity in elderly and younger patients alike. In patients with chronic stable heart failure, the NT-proBNP value carries the same 1-year prognostic information regardless of the age of the patient.

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Footnotes

  • Competing interests: None.

  • Ethics approval: Ethics committee approval from EC University of Hull, Hull, UK; EC University of Heidelberg, Heidelberg, Germany.

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