Subscribe to RSS
DOI: 10.1055/s-2005-862012
The role of NT-proBNP in chronic heart failure and renal insufficiency
Objectives: NT-proBNP is known as a marker of heart failure severity. Its significance in patients with both renal failure and chronic heart failure (CHF) is still unclear. We investigated the role of NT-proBNP in patients with renal failure and CHF.
Material and Methods: During past three years, 48 patients with CHF and renal insuffiziency (CAD n=31; DCM n=17) were enrolled. The mean age was 56±13 years; 37 patients were in NYHA classes III/IV. LV-EF was 28±16%. The creatinine levels were 3.8±3.1mg/mL. All patients underwent spiroergometry, ECG, echocardiography, right heart catheterization, routine blood controls and NT-proBNP levels (Roche, Germany). Follow-up was performed all three months, spiroergometry and Swan-Ganz catheterization were repeated yearly.
Results: The levels of NT-proBNP were high among all dialysis patients (n=9; 37.346±5.348 pg/mL) and renal insuffiziency (5.600±2.876 pg/mL). Due to heart failure treatment using β-blockers and ACE inhibitors the NT-proBNP levels remained equal or decreased due to therapy in 36 patients. The NYHA classification and ejection fraction remained unchanged during observation. In 12 patients the NT-proBNP levels significantly increased despite adequate treatment. The clinical condition of these patients markedly impaired with an enlargement of LV diameters, and decrease in ejection fraction, as well as an increase of NYHA class.
Conclusions: NT-proBNP has been found to be a valid marker of disease control in CHF and renal failure. Not the absolute values of NT-proBNP seems to be important but its dynamic. Patients with increasing levels of NT-proBNP despite adequate treatment should be referred to further surgical treatment options, e.g. LVAD support or heart transplantation.