Page 116 - Biomarkers for risk stratification and guidance in heart failure
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                                No. at risk
Follow-up (days)
Serial NT-proBNP measurements during and early after HF admission.
   62
94
83
70
60 60
84 74
62 57
36 23
57 44
68 54
53 36
16 13
     Fig. 1. Kaplan-Meier curve for (A) mortality and (B) the combined end point of HF hospitalization-free 5 survival according to the composite N-terminal pro-B-type natriuretic peptide (NT-proBNP) score.
Outpatient NT-proBNP Measurements and Prognosis
The prognostic value of changes in NT-proBNP at the outpatient clinic compared with only a single measurement seems to depend on the outpatient setting. One study reported that absolute NT-proBNP concentration at 3 months after acute HF admission had more predictive power in multivariate analysis than percentage change within 3 months (chi-square value of log NT-proBNP after 3 months 41.5, compared with 7.5 for NT-proBNP percentage change).13
Also in chronic stable HF, the prognostic power of absolute NT-proBNP concentration appears to be superior to relative changes in NT-proBNP. A subanalysis of the Val-HeFT trial, for example, demonstrated a higher prognostic discrimination of a single determination of NT-proBNP compared with relative changes after 4-month follow-up (AUC 0.70 vs 0.60, respectively).6
Changes in NT-proBNP concentration seem to have higher prognostic impact in outpatient destabilized HF; Bayes-Genis et al, for example, reported a 21% reduction in events for every 10% decrease in NT-proBNP within 2 weeks.14 In contrast, the absolute NT-proBNP concentration at 2 weeks lost its predictive power in multivariate analysis.
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