Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a β-blocker: Results from the Carvedilol Or Metoprolol European Trial (COMET) trial

• Published in: European journal of heart failure Vol. 9; no. 8; pp. 795 - 801
• Main 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
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2007; Elsevier
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Carbazoles - therapeutic use; Chronic Disease; chronic heart failure; Female; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - mortality; Humans; Male; Metoprolol - therapeutic use; Middle Aged; Natriuretic Peptide, Brain - blood; natriuretic peptides; Peptide Fragments - blood; Prognosis; Propanolamines - therapeutic use; treatment; Prognosis; Treatment; Chronic heart failure; Natriuretic peptides
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1016/j.ejheart.2007.07.010

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.