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NT-proBNP Testing: Any Value in Stable CHD?

The predictive value was statistically significant, but what’s the practical value for guiding secondary prevention?

In patients with acute decompensated heart failure, elevated levels of the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) have been associated with poor prognosis (Circulation 2002; 105:2392). To assess this marker's value in stable coronary heart disease (CHD), researchers prospectively studied 987 stable CHD patients (81% men; 18% with a history of heart failure) in the Heart and Soul Study. The cohort's median baseline NT-proBNP level was 175 pg/mL.

During a mean follow-up of 3.7 years, 256 patients (26%) experienced a cardiovascular (CV) event or died. The higher the baseline NT-proBNP level, the greater was the annual risk for CV events or death, ranging from 2.6% in the lowest NT-proBNP quartile (8–74 pg/mL) to 19.6% in the highest quartile (460 pg/mL). NT-proBNP testing also added statistically significant prognostic value to traditional baseline risk assessment, which included echocardiographic measures.

Comment: This study documents the potential value of NT-proBNP as a risk marker in patients with stable CHD. The findings are intriguing, but further research is required to determine whether NT-proBNP testing would help to improve outcomes in these patients. For now, the evidence is insufficient to justify measuring NT-proBNP as part of routine screening of stable CHD patients, whose need for aggressive therapy is already clear. Clinicians should continue to manage these high-risk patients according to current secondary-prevention guidelines (Journal Watch Cardiology Jun 8 2006). NT-proBNP might hold greater promise for determining therapy in intermediate-risk patients without CHD, but the marker’s predictive value in such patients has not been established.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology January 17, 2007

Citation(s):

Bibbins-Domingo K et al. N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP), cardiovascular events, and mortality in patients with stable coronary heart disease. JAMA 2007 Jan 10; 297:169-76.

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Konstam MA. Natriuretic peptides and cardiovascular events: More than a stretch. JAMA 2007 Jan 10; 297:212-4.

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• Medline abstract (Free)