Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis.

Our aim was to determine whether N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) levels are valuable for predicting prognosis in patients with infective endocarditis (IE). We analyzed measured plasma NT-pro-BNP levels at admission in 45 patients with definite IE. The primary end point was early surgery or in-hospital death. The other data recorded were baseline clinical, echocardiographic, and laboratory parameters. Thirty patients underwent early surgery, and 9 died in hospital. Univariate analysis revealed that log NT-pro-BNP, cTnI > or =0.03 ng/ml, New York Heart Association functional class III to IV symptoms, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and severe valvular regurgitation were associated with increased risk of reaching the primary end point. Cox proportional hazard regression analysis identified log NT-pro-BNP (hazard ratio 1.5; 95% confidence interval 1.2 to 1.9, p <0.001) as the only independent predictor of the primary end point. The log NT-pro-BNP cut-off value with the highest sensitivity (97%) and specificity (92%) for predicting primary end point was 7.2 (1,500 pg/ml). Patients with NT-pro-BNP level > or =1,500 pg/ml had significantly lower event-free survival than others. In conclusion, admission NT-pro-BNP is of prognostic value in patients with IE. The combination of admission NT-pro-BNP and cTnI levels appears to have even greater value for risk stratification in this patient group.

[1]  C. Mitaka,et al.  Plasma alpha-atrial natriuretic peptide concentrations in acute respiratory failure associated with sepsis: preliminary study. , 1990, Critical care medicine.

[2]  F. Quitkin Depression With Atypical Features: Diagnostic Validity, Prevalence, and Treatment. , 2002, Primary care companion to the Journal of clinical psychiatry.

[3]  H. Imura,et al.  Increased human brain natriuretic peptide in congestive heart failure. , 1990, The New England journal of medicine.

[4]  H. Akiskal,et al.  Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II? , 2005, Journal of affective disorders.

[5]  G. Fonarow,et al.  Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure , 2003, Circulation.

[6]  M. Drazner,et al.  B-type natriuretic peptide in cardiovascular disease , 2003, The Lancet.

[7]  H. Rickli,et al.  B‐type natriuretic peptide in patients with sepsis and preserved left ventricular ejection fraction , 2005, European journal of heart failure.

[8]  M. Trivedi,et al.  The link between depression and physical symptoms. , 2004, Primary care companion to the Journal of clinical psychiatry.

[9]  T. Fehr,et al.  Elevation of troponin I in sepsis and septic shock , 2001, Intensive Care Medicine.

[10]  C. O'connor,et al.  Cardiac troponins in congestive heart failure. , 1999, American heart journal.

[11]  Anand Kumar,et al.  Myocardial dysfunction in the patient with sepsis , 2002, Current opinion in critical care.

[12]  K. Werdan,et al.  Plasma atrial natriuretic peptide and brain natriuretic peptide are increased in septic shock: impact of interleukin-6 and sepsis-associated left ventricular dysfunction , 2003, Intensive Care Medicine.

[13]  C. Price,et al.  B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertrophy. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[14]  L. Køber,et al.  N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. , 2005, The New England journal of medicine.

[15]  Leonardo Mancini,et al.  Risk of embolization after institution of antibiotic therapy for infective endocarditis. , 2002, Journal of the American College of Cardiology.

[16]  R. Califf,et al.  N‐Terminal Pro‐Brain Natriuretic Peptide and Other Risk Markers for the Separate Prediction of Mortality and Subsequent Myocardial Infarction in Patients With Unstable Coronary Artery Disease: A Global Utilization of Strategies To Open occluded arteries (GUSTO)‐IV Substudy , 2003, Circulation.

[17]  D. Durack,et al.  New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. , 1994, The American journal of medicine.

[18]  M. Borggrefe,et al.  Prognostic Value of Plasma N-Terminal Pro-Brain Natriuretic Peptide in Patients With Severe Sepsis , 2005, Circulation.

[19]  W. Littler,et al.  Role of troponin I in active infective endocarditis. , 2004, The American journal of cardiology.

[20]  M. Thase New directions in the treatment of atypical depression. , 2006, The Journal of clinical psychiatry.

[21]  V. Fowler,et al.  Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[22]  G. Lamas,et al.  N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. , 1994, Circulation.

[23]  S. Gottlieb,et al.  Prognostic importance of atrial natriuretic peptide in patients with chronic heart failure. , 1989, Journal of the American College of Cardiology.

[24]  J. Rouleau,et al.  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 , 2004, Circulation.

[25]  Olli Tenovuo,et al.  Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. , 2002, The American journal of psychiatry.