Triiodothyronine and brain natriuretic peptide: similar long-term prognostic values for chronic heart failure

Tex Heart Inst J. 2010;37(5):538-46.


Although low levels of free triiodothyronine and high levels of brain natriuretic peptide have been shown as independent predictors of death in chronic heart failure patients, few studies have compared their prognostic values. The aim of this prospective study was to measure free triiodothyronine and brain natriuretic peptide levels and to compare their prognostic values among such patients.A total of 334 patients (mean age, 62 ± 13 yr; 218 men) with ischemic and nonischemic dilated cardiomyopathy were included in the study. The primary endpoint was a major cardiac event.During the follow-up period, 92 patients (28%) experienced a major cardiac event. Mean free triiodothyronine levels were lower and median brain natriuretic peptide levels were higher in patients with major cardiac events than in those without. A significant negative correlation was found between free triiodothyronine and brain natriuretic peptide levels. Receiver operating characteristic curve analysis showed that the predictive cutoff values were < 2.12 pg/mL for free triiodothyronine and > 686 pg/mL for brain natriuretic peptide. Cumulative survival was significantly lower among patients with free triiodothyronine < 2.12 pg/mL and among patients with brain natriuretic peptide > 686 pg/mL. In multivariate analysis, the significant independent predictors of major cardiac events were age, free triiodothyronine, and brain natriuretic peptide.In the present study, free triiodothyronine and brain natriuretic peptide had similar prognostic values for predicting long-term prognosis in chronic heart failure patients. These results also suggested that combining these biomarkers may provide an important risk indicator for patients with heart failure.

Keywords: Biological markers/blood; cardiomyopathy, dilated/blood; euthyroid sick syndromes; heart failure/complications/chronic/pathology; hypothalamo-hypophyseal system/metabolism; multivariate analysis; natriuretic peptide, brain/blood; prognosis; survival rate; triiodothyronine/blood/deficiency.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cardiomyopathy, Dilated / blood
  • Cardiomyopathy, Dilated / complications*
  • Cardiomyopathy, Dilated / mortality
  • Chi-Square Distribution
  • Chronic Disease
  • Down-Regulation
  • Female
  • Heart Failure / blood*
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • ROC Curve
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Triiodothyronine / blood*
  • Turkey
  • Up-Regulation


  • Biomarkers
  • Triiodothyronine
  • Natriuretic Peptide, Brain