Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a β-blocker:: Results from the Carvedilol Or Metoprolol European Trial (COMET) trial

Background: Plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP) are increased in patients with chronic heart failure (CHF). Beta-blockers (BB) may influence these levels but it is unclear whether changes in NT-pro BNP reflect concomitant changes in prognosis. Objectives: To assess the prognostic importance of NT-pro BNP at baseline and during follow-up, in patients in whom beta-blocker therapy is initiated. Methods: In COMET, 3 029 patients with CHF in NYHA class II-IV and EF < 35% were randomised to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Blood samples were collected for the measurement of NT-pro BNP at baseline (n= 1559) and during follow-up (n=309). Results: Baseline plasma concentrations of NT-pro BNP above the median (1242 pg/ml) were associated with higher all-cause mortality (RR 2.77; 95% CI 2.33-3.3,p < 0.001). Patientswho achievedNT-pro BNP levels < 400pg/ml during follow-up had a lower subsequent mortality (RR 0.32; 95% CI 0.15-0.69, p= 0.004). Conclusions: The plasma concentration of NT-pro, BNP is a powerful predictor of mortality in patients with CHF. Patients who achieve an NT-pro BNP of < 400 pg/ml subsequent to treatment with a beta-blocker have a favourable prognosis. (c) 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.