The clinical assessment of heart failure is difficult; it is difficult to determine which patients have heart failure and, once the diagnosis is established, to predict which patients are at risk of death or further cardiovascular events.

Factors shown to be predictors of mortality in heart failure are: increasing age, a history of diabetes mellitus or renal dysfunction, higher New York Heart Association class, lower left ventricular ejection fraction, lower sodium concentrations, lower body mass index, lower blood pressure, the presence of ankle oedema, and lower quality of life scores.
However, none of these is a strong predictor.

A growing interest has emerged in the predictive value of B-type natriuretic peptide ( BNP ).

The natriuretic peptides are released by the heart in response to myocardial tension and increased intravascular volume.

A researchers group, led by Jenny A Doust from Centre for General Practice, School of Medicine, University of Queensland ( Australia ) , reviewed studies assessing BNP for prognosis in patients with heart failure or asymptomatic patients.

A total of 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients.

In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death.

Raised BNP values also predicted survival in patients not known to have heart failure, with the risk doubled in patients with a BNP value greater than 20 pg/ml.

The results of the studies in this review have showed that BNP is a strong prognostic indicator for both asymptomatic patients and for patients with heart failure at all stages of disease.

Source : British Medical Journal, 2005


XagenaMedicine2005