Role of BNP levels on the prognosis of decompensated advanced heart failure.

BACKGROUND: Heart failure (HF) is a condition with poor outcome, especially in advanced cases. Determination of B-type natriuretic peptide (BNP) levels is useful in the diagnosis of cardiac decompensation and has also been proving useful in the prognostic evaluation. OBJECTIVES: To verify whether BNP levels are able to identify patients with a poorer outcome and whether it is an independent prognostic factor considering age, gender, cardiac and renal functions, as well as the cause of heart disease. METHODS: 189 patients in functional class III/IV advanced HF were studied. All had systolic dysfunction and had their BNP levels determined during hospitalization. Variables related to mortality were studied using univariate and multivariate analyses. RESULTS: BNP levels were higher in patients who died in the first year of follow-up (1,861.9 versus 1,408.1 pg/dL; p = 0.044) and in chagasic patients (1,985 versus 1,452 pg/mL; p = 0.001); the latter had a higher mortality rate in the first year of follow-up (56% versus 35%; p = 0.010). The ROC curve analysis showed that the BNP level of 1,400 pg/mL was the best predictor of events; high levels were associated with lower LVEF (0.23 versus 0.28; p = 0.002) and more severe degree of renal dysfunction (mean urea 92 versus 74.5 mg/dL; p = 0.002). CONCLUSION: In advanced HF, high BNP levels identified patients at higher risk of a poorer outcome. Chagasic patients showed higher BNP levels than those with heart diseases of other causes, and have poorer prognosis.

Papel dos níveis de BNP no prognóstico da insuficiência cardíaca avançada descompensada / Role of BNP levels on the prognosis of decompensated advanced heart failure

FUNDAMENTO: A insuficiência cardíaca (IC) é doença que cursa com má evolução, especialmente naqueles com IC avançada. A dosagem de peptídeo natriurético tipo B(BNP), ao lado da utilidade no diagnóstico da descompensação cardíaca, vem se mostrando útil na avaliação prognóstica. OBJETIVOS: Verificar se os níveis de BNP identificam quais pacientes evoluiriam pior e se o BNP seria fator independente de mortalidade considerando-se idade, sexo, funções cardíaca e renal e etiologia da cardiopatia. MÉTODOS: 189 pacientes com IC avançada em classe funcional III/IV foram estudados. Todos tinham disfunção sistólica e dosaram-se os níveis de BNP na hospitalização. Analisaram-se as variáveis relacionadas com a mortalidade através de análises univariada e multivariada. RESULTADOS: Os níveis de BNP foram mais elevados nos pacientes que morreram no primeiro ano de seguimento (1.861,9 versus 1.408,1 pg/dL; p = 0,044) e nos chagásicos (1.985 versus 1.452 pg/mL; p = 0,001), e esses pacientes chagásicos tiveram maior mortalidade no primeiro ano de seguimento (56% versus 35%; p = 0,010). Pela curva ROC, o valor de BNP de 1.400 pg/mL foi o melhor preditor de eventos, estando os valores elevados associados a FEVE mais baixa (0,23 versus 0,28; p = 0,002) e maior grau de disfunção renal (ureia média 92 versus 74,5 mg/dL; p = 0,002). CONCLUSÃO: Na IC avançada, os níveis elevados de BNP identificam pacientes com maior potencial de pior evolução. Os pacientes chagásicos apresentam níveis mais elevados de BNP do que as outras etiologias e têm pior evolução.

BACKGROUND: Heart failure (HF) is a condition with poor outcome, especially in advanced cases. Determination of B-type natriuretic peptide (BNP) levels is useful in the diagnosis of cardiac decompensation and has also been proving useful in the prognostic evaluation. OBJECTIVES: To verify whether BNP levels are able to identify patients with a poorer outcome and whether it is an independent prognostic factor considering age, gender, cardiac and renal functions, as well as the cause of heart disease. METHODS: 189 patients in functional class III/IV advanced HF were studied. All had systolic dysfunction and had their BNP levels determined during hospitalization. Variables related to mortality were studied using univariate and multivariate analyses. RESULTS: BNP levels were higher in patients who died in the first year of follow-up (1,861.9 versus 1,408.1 pg/dL; p = 0.044) and in chagasic patients (1,985 versus 1,452 pg/mL; p = 0.001); the latter had a higher mortality rate in the first year of follow-up (56% versus 35%; p = 0.010). The ROC curve analysis showed that the BNP level of 1,400 pg/mL was the best predictor of events; high levels were associated with lower LVEF (0.23 versus 0.28; p = 0.002) and more severe degree of renal dysfunction (mean urea 92 versus 74.5 mg/dL; p = 0.002). CONCLUSION: In advanced HF, high BNP levels identified patients at higher risk of a poorer outcome. Chagasic patients showed higher BNP levels than those with heart diseases of other causes, and have poorer prognosis.

Desenvolvimento sistêmico da insuficiência cardíaca / Sistemic development of heart failure

A ativação do sistema nervoso simpático e do sistema renina-angiotensina-aldosterona são as principais adaptações neuro-hormonais visando à manutenção da perfusão tecidual nos pacientes com insuficiência cardíaca. Paralelamente à ativação neuro-hormonal, a remodelação ventricular contribui para a progressão da disfunção ventricular. Entretanto, a insuficiência cardíaca não é somente...