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Variability of NT-proBNP plasma and urine levels in patients with stable heart failure: a 2-year follow-up study
  1. Raquel Cortés1,
  2. Miguel Rivera1,
  3. Antonio Salvador2,
  4. Vicente Bertomeu3,
  5. Fernando García de Burgos4,
  6. Esther Roselló-Lletí1,
  7. Manuel Portolés5,
  8. Rafael Payá6,
  9. Luis Martínez-Dolz2,
  10. Vicente Climent7
  1. 1Cardiology Unit, Research Centre, Hospital Universitario La Fe, Valencia, Spain
  2. 2Cardiology Unit, Hospital Universitario La Fe, Valencia, Spain
  3. 3Cardiology Unit, Hospital Universitario San Juan, Alicante, Spain
  4. 4Cardiology Unit, Hospital General Universitario de Elche, Alicante, Spain
  5. 5Cell Biology and Pathology Unit, Research Centre, Hospital Universitario La Fe, Valencia, Spain
  6. 6Cardiology Unit, Hospital General, Valencia, Spain
  7. 7Cardiology Unit, Hospital General Universitario, Alicante, Spain
  1. Correspondence to:
    Dr M Rivera Otero
    Jose Maria Haro, 59, puerta 59, 46022 Valencia, Spain; rivera_jmi{at}


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.

  • 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
  • natriuretic peptides
  • urine
  • plasma
  • stability
  • variability

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