Prognosis of Stage A or B Heart Failure Patients With Elevated B-type Natriuretic Peptide Levels

Background: Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [ANA] HF Stages A and B), and compared prognosis with Stage C/D patients. Methods and Results: Outpatients referred for echocardiogram (n = 829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100 pg/mL). Primary outcome was death or cardiac hospitalization at I year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62-2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11-3.28). Conclusions: Individuals without any history of HF but with BNP 100 pg/mL are at equal or higher risk than those with a HF history whose BNP is <100 pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events. (J Cardiac Fail 2010;16:93-98)