The prognostic value of individual NT-proBNP values in chronic heart failure does not change with advancing age
- L Frankenstein1,
- A L Clark2,
- K Goode2,
- L Ingle3,
- A Remppis1,
- D Schellberg1,
- F Grabs1,
- M Nelles1,
- J G F Cleland2,
- H A Katus1,
- C Zugck1
- 1University of Heidelberg, Heidelberg, Germany
- 2Department of Academic Cardiology, University of Hull, Kingston-upon-Hull, UK
- 3Carnegie Research Institute, Leeds Metropolitan University, Leeds, UK
- 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
- Accepted 23 December 2008
- Published Online First 15 January 2009
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.
Footnotes
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Competing interests: None.
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Ethics approval: Ethics committee approval from EC University of Hull, Hull, UK; EC University of Heidelberg, Heidelberg, Germany.
