Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure - A substudy of the carvedilol prospective randomized cumulative survival (COPERNICUS) trial CIRCULATION Hartmann, F., Packer, M., COATS, A. J., Fowler, M. B., Krum, H., Mohacsi, P., Rouleau, J. L., Tendera, M., Castaigne, A., Anker, S. D., Amann-Zalan, I., Hoersch, S., Katus, H. A. 2004; 110 (13): 1780-1786


The utility of N-terminal proBNP (NT-proBNP) to predict the occurrence of death and hospitalization was prospectively evaluated in the COPERNICUS study, which enrolled patients with an ejection fraction <25% and symptoms of chronic congestive heart failure at rest or on minimal exertion.Baseline plasma concentrations of NT-proBNP were measured in a subgroup of 814 men and 197 women with symptoms at rest or on minimal exertion who were enrolled in the COPERNICUS study and were randomized to placebo (n=506) or carvedilol (n=505). Values of NT-proBNP were markedly increased despite the requirement that patients be euvolemic before the start of treatment (mean+/-SD, 3235+/-4392 pg/mL; median, 1767 pg/mL). By univariate Cox regression analysis, NT-proBNP was found to be a powerful predictor of subsequent all-cause mortality (relative risk [RR], 2.7; 95% CI, 1.7 to 4.3; P=0.0001 for above versus below median) and all-cause mortality or hospitalization for heart failure (RR, 2.4; 95% CI, 1.8 to 3.4; P=0.0001 for above versus below median). The predictive value of NT-proBNP was similar when both placebo and carvedilol patients were analyzed separately. No significant interaction was found between NT-proBNP and treatment group (P=0.93 for above- versus below-median NT-proBNP).NT-proBNP was consistently associated with increased risk for all-cause mortality and for all-cause mortality or hospitalization for heart failure in patients with severe congestive heart failure, even in those who were clinically euvolemic. This marker therefore may be a useful tool in risk stratification of patients with severe congestive heart failure.

View details for DOI 10.1161/01.CIR.0000143059.68996.A7

View details for Web of Science ID 000224128400013

View details for PubMedID 15381643