Valvular heart disease
Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Active Infective Endocarditis

https://doi.org/10.1016/j.amjcard.2006.12.071Get rights and content

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 ≥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 ≥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.

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Patients

From May 2004 to May 2005, a total of 235 patients with suspected IE were evaluated at the Kosuyolu Heart and Research Hospital (Istanbul, Turkey), a tertiary center. Forty-eight patients met modified Duke’s criteria9 for definite IE. Three patients with pacemaker IE were excluded, and the remaining 45 patients were enrolled in this prospective study. In addition to plasma NT–pro-BNP and cTnI levels at admission, clinical, echocardiographic, and laboratory findings were recorded for each

Results

Thirty-four patients (76%) were male. Age range was 9 to 75 years (median 41). Underlying conditions related to IE were bicuspid aortic valve (11 patients, 24%), rheumatic heart disease (8 patients, 18%), degenerative heart disease (8 patients, 18%), prosthetic heart valves (8 patients, 18%), congenital heart disease (4 patients, 9%), mitral valve prolapse (1 patient, 2%), and obstructive hypertrophic cardiomyopathy (1 patient, 2%). Four subjects (9%) had no cardiac abnormality. None had a

Discussion

Our results suggest that NT–pro-BNP may be a valuable laboratory marker that allows risk stratification of patients with definite IE. Patients with IE had markedly increased NT–pro-BNP levels at admission (median 4,133 pg/ml). We also observed that patients who required early surgery or died during hospitalization had a significantly higher mean admission NT–pro-BNP than those who did not experience the primary end point.

In addition, compared with the prognostic value of NT–pro-BNP alone, we

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This study was supported by a grant from the Turkish Society of Cardiology, Istanbul, Turkey.

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