Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

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