Zusammenfassung
Background: Natriuretic peptides are considered as reliable indicators of left-heart failure (HF) and are useful for differential diagnosis of dyspnoea. Aim: We evaluated the clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with chronic hypercapnic respiratory failure (CHRF). Methods: In 60 patients with CHRF, plasma concentrations of NT-proBNP were ...
Zusammenfassung
Background: Natriuretic peptides are considered as reliable indicators of left-heart failure (HF) and are useful for differential diagnosis of dyspnoea. Aim: We evaluated the clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with chronic hypercapnic respiratory failure (CHRF). Methods: In 60 patients with CHRF, plasma concentrations of NT-proBNP were assessed at baseline and after treatment including non-invasive ventilation (NIV). The relationship of NT-proBNP to disease severity and its predictive value for survival were evaluated up to 4 years. Results: NT-proBNP levels were markedly elevated in patients with CHRF (n = 60; geometric mean (SD) 546.4 (4.9) pg/mL; p < 0.001) compared to healthy controls (n = 182; 49.0 (2.2) pg/mL). After excluding patients with concomitant HF or renal impairment, levels were still increased (n=43; 393.2 (3.8) pg/mL; p < 0.001). According to multivariate regression, hypoxia and exacerbation independently determined NT-proBNP levels (p < 0.05 each). After initiation of NIV, blood gases and lung function improved and NT-proBNP decreased (-31.3 (0.3)%; p < 0.001). During 22.5 (2.2) months follow-up, NT-proBNP was not significantly associated with survival in the total population, however, the subgroup of patients with levels > 722pg/mL (67th percentile) and no adherence to NIV displayed poor prognosis (hazard ratio = 0.21; 95%-CI = 0.022-0.580; p = 0.0091). Conclusions: NT-proBNP was highly elevated in patients with CHRF and correlated with the degree of respiratory impairment and exacerbation. Correspondingly, treatment including NIV led to reduction of NT-proBNP These data indicate a potential role of NTproBNP in assessing disease severity, treatment efficacy and prognosis in CHRF. (c) 2007 Elsevier Ltd. All rights reserved.
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