Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure: A substudy of the carvedilol prospective randomized cumulative survival (COPERNICUS) trial

Franz Hartmann, Milton Packer, Andrew J S Coats, Michael B. Fowler, Henry Krum, Paul Mohacsi, Jean L. Rouleau, Michal Tendera, Alain Castaigne, Stefan D. Anker, Ildiko Amann-Zalan, Silke Hoersch, Hugo A. Katus

Research output: Contribution to journalArticle

243 Citations (Scopus)

Abstract

Background - The utility of N-terminal proBNP (NT-proBNP) to predict the occurrence of death and hospitalization was prospectively evaluated in the COPERNICUS study, which enrolled patients with an ejection fraction <25% and symptoms of chronic congestive heart failure at rest or on minimal exertion. Methods and Results - Baseline plasma concentrations of NT-proBNP were measured in a subgroup of 814 men and 197 women with symptoms at rest or on minimal exertion who were enrolled in the COPERNICUS study and were randomized to placebo (n=506) or carvedilol (n=505). Values of NT-proBNP were markedly increased despite the requirement that patients be euvolemic before the start of treatment (mean±SD, 3235±4392 pg/mL; median, 1767 pg/mL). By univariate Cox regression analysis, NT-proBNP was found to be a powerful predictor of subsequent all-cause mortality (relative risk [RR], 2.7; 95% CI, 1.7 to 4.3; P=0.0001 for above versus below median) and all-cause mortality or hospitalization for heart failure (RR, 2.4; 95% CI, 1.8 to 3.4; P=0.0001 for above versus below median). The predictive value of NT-proBNP was similar when both placebo and carvedilol patients were analyzed separately. No significant interaction was found between NT-proBNP and treatment group (P=0.93 for above- versus below-median NT-proBNP). Conclusions - NT-proBNP was consistently associated with increased risk for all-cause mortality and for all-cause mortality or hospitalization for heart failure in patients with severe congestive heart failure, even in those who were clinically euvolemic. This marker therefore may be a useful tool in risk stratification of patients with severe congestive heart failure.

Original languageEnglish (US)
Pages (from-to)1780-1786
Number of pages7
JournalCirculation
Volume110
Issue number13
DOIs
StatePublished - Sep 28 2004

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Brain Natriuretic Peptide
Heart Failure
Survival
Hospitalization
Mortality
Placebos
carvedilol
pro-brain natriuretic peptide (1-76)
Regression Analysis
Therapeutics

Keywords

  • Heart failure
  • Natriuretic peptides
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure : A substudy of the carvedilol prospective randomized cumulative survival (COPERNICUS) trial. / Hartmann, Franz; Packer, Milton; Coats, Andrew J S; Fowler, Michael B.; Krum, Henry; Mohacsi, Paul; Rouleau, Jean L.; Tendera, Michal; Castaigne, Alain; Anker, Stefan D.; Amann-Zalan, Ildiko; Hoersch, Silke; Katus, Hugo A.

In: Circulation, Vol. 110, No. 13, 28.09.2004, p. 1780-1786.

Research output: Contribution to journalArticle

Hartmann, F, Packer, M, Coats, AJS, Fowler, MB, Krum, H, Mohacsi, P, Rouleau, JL, Tendera, M, Castaigne, A, Anker, SD, Amann-Zalan, I, Hoersch, S & Katus, HA 2004, 'Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure: A substudy of the carvedilol prospective randomized cumulative survival (COPERNICUS) trial', Circulation, vol. 110, no. 13, pp. 1780-1786. https://doi.org/10.1161/01.CIR.0000143059.68996.A7
Hartmann, Franz ; Packer, Milton ; Coats, Andrew J S ; Fowler, Michael B. ; Krum, Henry ; Mohacsi, Paul ; Rouleau, Jean L. ; Tendera, Michal ; Castaigne, Alain ; Anker, Stefan D. ; Amann-Zalan, Ildiko ; Hoersch, Silke ; Katus, Hugo A. / Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure : A substudy of the carvedilol prospective randomized cumulative survival (COPERNICUS) trial. In: Circulation. 2004 ; Vol. 110, No. 13. pp. 1780-1786.
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abstract = "Background - The utility of N-terminal proBNP (NT-proBNP) to predict the occurrence of death and hospitalization was prospectively evaluated in the COPERNICUS study, which enrolled patients with an ejection fraction <25{\%} and symptoms of chronic congestive heart failure at rest or on minimal exertion. Methods and Results - Baseline plasma concentrations of NT-proBNP were measured in a subgroup of 814 men and 197 women with symptoms at rest or on minimal exertion who were enrolled in the COPERNICUS study and were randomized to placebo (n=506) or carvedilol (n=505). Values of NT-proBNP were markedly increased despite the requirement that patients be euvolemic before the start of treatment (mean±SD, 3235±4392 pg/mL; median, 1767 pg/mL). By univariate Cox regression analysis, NT-proBNP was found to be a powerful predictor of subsequent all-cause mortality (relative risk [RR], 2.7; 95{\%} CI, 1.7 to 4.3; P=0.0001 for above versus below median) and all-cause mortality or hospitalization for heart failure (RR, 2.4; 95{\%} CI, 1.8 to 3.4; P=0.0001 for above versus below median). The predictive value of NT-proBNP was similar when both placebo and carvedilol patients were analyzed separately. No significant interaction was found between NT-proBNP and treatment group (P=0.93 for above- versus below-median NT-proBNP). Conclusions - NT-proBNP was consistently associated with increased risk for all-cause mortality and for all-cause mortality or hospitalization for heart failure in patients with severe congestive heart failure, even in those who were clinically euvolemic. This marker therefore may be a useful tool in risk stratification of patients with severe congestive heart failure.",
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T2 - A substudy of the carvedilol prospective randomized cumulative survival (COPERNICUS) trial

AU - Hartmann, Franz

AU - Packer, Milton

AU - Coats, Andrew J S

AU - Fowler, Michael B.

AU - Krum, Henry

AU - Mohacsi, Paul

AU - Rouleau, Jean L.

AU - Tendera, Michal

AU - Castaigne, Alain

AU - Anker, Stefan D.

AU - Amann-Zalan, Ildiko

AU - Hoersch, Silke

AU - Katus, Hugo A.

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N2 - Background - The utility of N-terminal proBNP (NT-proBNP) to predict the occurrence of death and hospitalization was prospectively evaluated in the COPERNICUS study, which enrolled patients with an ejection fraction <25% and symptoms of chronic congestive heart failure at rest or on minimal exertion. Methods and Results - Baseline plasma concentrations of NT-proBNP were measured in a subgroup of 814 men and 197 women with symptoms at rest or on minimal exertion who were enrolled in the COPERNICUS study and were randomized to placebo (n=506) or carvedilol (n=505). Values of NT-proBNP were markedly increased despite the requirement that patients be euvolemic before the start of treatment (mean±SD, 3235±4392 pg/mL; median, 1767 pg/mL). By univariate Cox regression analysis, NT-proBNP was found to be a powerful predictor of subsequent all-cause mortality (relative risk [RR], 2.7; 95% CI, 1.7 to 4.3; P=0.0001 for above versus below median) and all-cause mortality or hospitalization for heart failure (RR, 2.4; 95% CI, 1.8 to 3.4; P=0.0001 for above versus below median). The predictive value of NT-proBNP was similar when both placebo and carvedilol patients were analyzed separately. No significant interaction was found between NT-proBNP and treatment group (P=0.93 for above- versus below-median NT-proBNP). Conclusions - NT-proBNP was consistently associated with increased risk for all-cause mortality and for all-cause mortality or hospitalization for heart failure in patients with severe congestive heart failure, even in those who were clinically euvolemic. This marker therefore may be a useful tool in risk stratification of patients with severe congestive heart failure.

AB - Background - The utility of N-terminal proBNP (NT-proBNP) to predict the occurrence of death and hospitalization was prospectively evaluated in the COPERNICUS study, which enrolled patients with an ejection fraction <25% and symptoms of chronic congestive heart failure at rest or on minimal exertion. Methods and Results - Baseline plasma concentrations of NT-proBNP were measured in a subgroup of 814 men and 197 women with symptoms at rest or on minimal exertion who were enrolled in the COPERNICUS study and were randomized to placebo (n=506) or carvedilol (n=505). Values of NT-proBNP were markedly increased despite the requirement that patients be euvolemic before the start of treatment (mean±SD, 3235±4392 pg/mL; median, 1767 pg/mL). By univariate Cox regression analysis, NT-proBNP was found to be a powerful predictor of subsequent all-cause mortality (relative risk [RR], 2.7; 95% CI, 1.7 to 4.3; P=0.0001 for above versus below median) and all-cause mortality or hospitalization for heart failure (RR, 2.4; 95% CI, 1.8 to 3.4; P=0.0001 for above versus below median). The predictive value of NT-proBNP was similar when both placebo and carvedilol patients were analyzed separately. No significant interaction was found between NT-proBNP and treatment group (P=0.93 for above- versus below-median NT-proBNP). Conclusions - NT-proBNP was consistently associated with increased risk for all-cause mortality and for all-cause mortality or hospitalization for heart failure in patients with severe congestive heart failure, even in those who were clinically euvolemic. This marker therefore may be a useful tool in risk stratification of patients with severe congestive heart failure.

KW - Heart failure

KW - Natriuretic peptides

KW - Prognosis

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