The prognostic value of repeated measurement of N-terminal pro-B-type natriuretic peptide in patients with chronic heart failure due to left ventricular systolic dysfunction

Eur J Heart Fail. 2009 Apr;11(4):367-77. doi: 10.1093/eurjhf/hfp003. Epub 2009 Jan 29.


Aims: Decreased N-terminal pro-B-type natriuretic peptide (NT-proBNP) during treatment of chronic heart failure (CHF) is associated with improved prognosis. However, there is lack of data from community-based HF programmes. We hypothesized that plasma levels of NT-proBNP, measured after optimization of pharmacotherapy in patients with CHF, may provide independent prognostic information when compared with baseline values and conventional prognostic markers.

Methods and results: N-terminal pro-B-type natriuretic peptide was measured in 354 patients with CHF and left ventricular ejection fraction <45%, who had recently been enrolled in a community-based HF programme. Patients underwent a 6 min walk test and clinical, echocardiographic and laboratory examinations. Pharmacotherapy was optimized; 318 patients survived until the second examination and measurement of NT-proBNP, which was performed between the 4th and 6th month of follow-up. During a median follow-up of 38.8 months, 125 patients died. Follow-up log NT-proBNP was a better predictor of death than either baseline log NT-proBNP or change in NT-proBNP (chi(2): 46.5 vs. 30.4 and 12.5, all P < 0.001). N-terminal pro-B-type natriuretic peptide was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalizations after baseline or follow-up assessment.

Conclusion: The measurement of NT-proBNP after optimization of pharmacotherapy provides stronger prognostic information than either the baseline value, the change in NT-proBNP, or other conventional methods of assessment.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Echocardiography
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Heart Failure, Systolic / blood*
  • Heart Failure, Systolic / etiology
  • Heart Failure, Systolic / mortality
  • Humans
  • Luminescent Measurements
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Prospective Studies
  • Protein Precursors
  • Risk Assessment
  • Risk Factors
  • Stroke Volume / physiology*
  • Survival Rate / trends
  • Systole
  • Time Factors
  • United Kingdom / epidemiology
  • Ventricular Dysfunction, Left / blood
  • Ventricular Dysfunction, Left / complications*
  • Ventricular Dysfunction, Left / physiopathology


  • Peptide Fragments
  • Protein Precursors
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain