Prognostic Significance of First Week NT-ProBNP Levels in Heart Failure OC14-OC17
Dr. Siba Prasad Dalai,
Senior Resident, Department of Medicine, Ims and SUM Hospital, Bhubaneswar-751003, Odisha, India.
Introduction: Clinical history, signs and symptoms along with non-invasive imaging help in diagnosis and management of Heart Failure (HF). Limited data exists in evaluating the role of cardiac biomarkers in diagnostic and prognostic work up in cases with clinical evidence of HF in an Indian setup.
Aim: The aim was to find out if first week N-Terminal -pro Brain Natriuretic Peptide (NT-proBNP) levels can be used as a prognostic indicator and to correlate with duration of hospital stay and mortality during the course of treatment and follow-up.
Materials and Methods: A hospital based cross-sectional observational study was carried out for a period of two years and 160 patients with clinical evidence of HF according to Framingham’s criteria irrespective of aetiology and ejection fraction were included in the study. NT-proBNP were estimated at admission, at one-week interval and at discharge. NT-proBNP levels were correlated with duration of hospital stay and mortality during the course of treatment and follow-up.
Results: Patients with Rheumatic Heart Disease (RHD) had the highest mean NT-proBNP levels even with higher ejection fractions. Mean NT-proBNP levels in patients with Cor-pulmonale were significantly lower (3634.8 pg/dL) than patients of HF with non-pulmonary cause (8418 pg/dL). Patients with NT-proBNP levels more than 15,000 pg/dL invariably stayed for more than two weeks. The decline of NT-proBNP levels more than 90% of the initial values in one week follow up were prognostic marker for recovery (p<0.01). Patients who had admission NT-proBNP levels of more than 10,000 pg/dL, and those cases with fall of NT-proBNP levels less than 50% after one week of therapy had increased duration of hospital stay and or higher risk of mortality.
Conclusion: First week NT-proBNP can be used routinely in monitoring the response to therapy, prognosticate the duration of hospital stay, outcome in HF.