Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a beta-blocker: results from the Carvedilol Or Metoprolol European Trial (COMET) trial |
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| Authors: | Olsson Lars G Swedberg Karl Cleland John G F Spark Phillip A Komajda Michel Metra Marco Torp-Pedersen Christian Remme Willem J Scherhag Armin Poole-Wilson Philip;COMET Investigators |
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| Institution: | 1. Department of Emergency and Cardiovascular Medicine Sahlgrenska Academy, G?teborg University, G?teborg, Sweden;2. Department of Emergency and Cardiovascular Medicine Sahlgrenska Academy, G?teborg University, G?teborg, SwedenCorresponding author. Department of Medicine, Sahlgrenska University Hospital/?stra, SE‐416 85 G?teborg, Sweden. Tel.: +46 313434078;3. fax: +46 31258933. E‐mail address:;4. University of Hull, Kingston upon Hull, United Kingdom;5. Nottingham Clinical Research Group, Nottingham, United Kingdom;6. Department of Cardiology, La Pitié‐Salpétrière Hospital, Paris, France;7. Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy;8. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark;9. Sticares Cardiovascular Research Institute, Rhoon, The Netherlands;10. Medical Clinic, University Hospital Mannheim, University of Heidelberg, Germany;11. National Heart and Lung Institute, Imperial College, London, United Kingdom |
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| Abstract: | 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, 3029 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). Patients who achieved NT-pro BNP levels<400 pg/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. |
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| Keywords: | chronic heart failure natriuretic peptides prognosis treatment |
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