The changes in NT-proBNP levels during follow-up do correlate with changes in clinical status for patients with HF destabilization, relative changes in NT-proBNP levels are better predictors of future clinical events.
In PIONEER-HF trial, the initiation of sacubitril–valsartan therapy after hemodynamic stabilization led to a greater reduction in the NT-proBNP concentration than enalapril therapy, a difference that was evident by the first week.1
Predischarge NT-proBNP levels or short-term change (in percentage terms) in NT-proBNP levels at 1-2 weeks is a strong predictor of clinical events.
In addition, NT-proBNP monitoring added independent prognostic information to clinical scoring in patients with destabilized HF.
Therefore, Serial monitoring for per cent change in NT-proBNP concentrations offers superior prognostic information to clinical assessment among outpatients with recent destabilized HF.
Eric J. Velazquez et al, N Engl J Med 2019; 380:539-548
62-year old woman
Key signs and symptoms
Acute severe chest pain for 10 days
Acute dyspnea (NYHA IV) for 3 days
No other specific signs and symptoms
Medical History
Diabetes with oral medication (Diabex 500 mg, Sitagliptin 100 mg) for 10 years
Smoking 40 pack years
Elevated CK-MB and Troponin levels
Clinical examination
BP 118/68 mmHg
RR 92/min
CXR
Chest X-Ray showed pleural effusion and pulmonary congestion
ECG
ECG shows no evidence of myocardial infarction
Coronary Angiogram
Coronary angiography shows significant narrowing on dRCA and dLCX
MRI
MRI: LGE (+)
EF: 35%
LVEDD: 5.2cm
MRI showed larger amount LGE which means infarcted myocardium
Serial NT-proBNP level and medication
At Admission
1st day
2nd day
At discharge
(5 days)
30 days
180 days
365 days
CK MB (*< 3.7 ng/mL)
18.40
1.60
0.63
0.53
0.58
0.22
–
Troponin I (< 0.046 ng/mL)
2.648
1.649
0.271
0.211
0.012
< 0.015
–
Initial NT-proBNP level was 7800, patient continued to experience dyspnea and chest pain. Serial measurement showed reduced levels.
Natriuretic peptides (NPs) are important predictors of outcomes in patients with acute myocardial infarction (AMI) but can change over time.1
Changes in the NT-proBNP levels over time are associated with concurrent changes in the EF or ventricular volumes and the clinical symptoms, suggesting that these natriuretic peptides may potentially serve as useful surrogate markers for patients with progressive remodeling after AMI.2
In addition, a persistently elevated NT-proBNP assessed 1 month after discharge was associated with a higher risk of mortality in patient with AMI.
Post discharge or early period risk stratification using NT-proBNP has the potential to identify higher risk patients after AMI.
Tom Hendriks et al The International Journal of Cardiovascular Imaging volume 33, pages 1415–1423 (2017).
Jens C. Nilsson MDa Am Heart J. Volume 143, Issue 4, April 2002, pages 696-702
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