Prognostic Value Of N-terminal Pro-Brain Naturetic Peptide And MUSIC Risk Score In Patients With Chronic Heart Failure

Objective:To measure the levels of N-terminal Pro-Brain Naturetic Peptide(NT-proBNP) from patients with chronic heart failure (CHF) during hospitalization and predischarge from hospital, evaluate MUerte Subita en Insuficiencia Cardiaca (MUSIC) risk score, and improve the prognosis on the suvival rate of CHF patients by comparing these three approaches. Methods: Consecutively admitted patients with CHF participated in this study. Levels of NT-proBNP during hospitalization and predischarge from hospital were measured by Roche Cardiac reader, The examination card was made by the Roche Corporation. The detectable level of NT-proBNP ranges from 60 to 3000ng/L, and 8% of intra-assay CVs and 12% of the intre-assay CVs, respectively. The manufacture’s instruction was strictly followed. Simultaneously, MUSIC risk score from patients of CHF was accounted by the top 10 risk factors including prior AVE, Indexed LA siae >26mm/m2, LV Ejection fraction≤35%, Atrial fibrillation, LBBB or IVCD,NSVT and frequent VPBs,eGFR<60ml/min/1.73m~2,Hyponatremia≤138mEq/L,NT-proBNP>1000 ng/L,Troponin-postive. Followed up for 180-292 days,endpoint events were recoreded, including cardiac death and decompensated heart failure readmission.The receiver operating characteristic (ROC) curve was uesed to assess the prognostic value of measuring NT-proBNP levels during hospitalization and predischarge from hospital and MUSIC risk score. The logistic regression models were used to assess the prognostic contribution of NT-proBNP levels during hospitalization and predischarge from hospital and MUSIC risk score.Survival function of patients with CHF was analyzed by Kaplan-Meier method. Results:112 consecutively admitted patients with CHF were involved, but 12 patients were excluded due to lost followed up or inadequate data, the Lost visit rate was 10.71%. Fnally,100 patients with CHF were included,the mean age was 70.14±11.25 years, 53 males, 47 females. During follow up 180-292days,34 endpoint events (34%) were recorded including 14 deaths (41.2%) and 20 patients(58.8%) being rehospitalization. The blood UA,CRE,LVDd,LVDs,the number of NYHA IV,LBBB were significantly higher in patients of the endpoints group than those of the non-endpoints group; the number of NYHA,Serum sodium were significantly lower in patients of the endpoints group than those of the non-endpoints group(P<0.05). However, LVEF and cTNT levels were not statistically different between the two group(sP>0.05). Levels of NT-proBNP during hospitalization and predischarge from hospital and MUSIC risk score were significantly higher in patients of the endpoints group than those of the non-endpoints group (all P=0.000). According to ROC curve, the level of NT-proBNP during hospitalization cut-off point was 2266ng/L (sensitivity: 64.7%, specificity: 75.8%); and the level of NT-proBNP during predischarge cut-off point was 1620.5ng/L(sensitivity:70.6%,specificity:92.4%)(P=0.000).Regarding MUSIC risk score, the cut-off point was19.5 (sensitivity:76.5%, specificity:75.8%) and the area under curve was 0.85, higer than the area under curve of NT-proBNP during hospitalization level(0.75)and NT-proBNP during predischarge from hospital level(0.82). In the logistic regression model, NT-proBNP during predischarge with the level >1620.5ng/L(OR=19.02) and the MUSIC risk score (OR=1.55) were independent predictors of endpoints in patients with heart failure. Kaplan-Meier analysis showed survival rate was significantly lower in patients with MUSIC risk score>19.5 group and NT-proBNP during predischarge level>1620.5ng/L group than MUSIC risk score<19.5 group and NT-proBNP during predischarge level<1620.5ng/L group. Conclusion:(1) The alteration of NT-proBNP level by multiple-time monitoring on patients of CHF during hospitalization and predischarge, especially during predischarge, is more helpful to improve the prognosis of survival rate of patients with CHF.(2)Both MUSIC risk score and NT-proBNP level during predischarge were independent predictors for endpoints in patients with CHF. CHF patients who are under the condition that NT-proBNP level during predischarge was >1620.5ng/Lor MUSIC risk score was >19.5 will be less accessible to the prognosis.(3) Compared to NT-proBNP level during predischarge, MUSIC risk score adds more prognostic value on the outcome of patients with CHF.