Supervisors info:
Γεράσιμος Σιάσος, Αναπληρωτής Καθηγητής,Ιατρική,ΕΚΠΑ
Ελένη Κυρίτση,Καθηγήτρια,Νοσηλευτική,ΑΤΕΙ
Δημήτριος Τούσουλης,Καθηγητής,Ιατρική,ΕΚΠΑ
Summary:
Brain Natriuretic Peptide mediates the prognosticator role of creatinine clearance on long-term cardiac events of patients with Acute Coronary Syndrome. A 10-years follow-up.
Abstract
Introduction: Although important advances have been performed in the interpretation and understanding of the pathophysiology behind heart failure, this chronic disease remains a challenge in the area of prognosis stratification. In this context, renal function and B-natriuretic peptide (BNP) remain predictors of much interest.
Purpose: to evaluate the role of renal function, through glomerular filtration rate (GFR) and BNP on the 10y ACS mortality of coronary patients with heart failure.
Material and Methods: from May 2006 to March 2009, 1,000 consecutive patients who were hospitalized with ACS diagnosis were enrolled in the study. In 2016, the 10y follow-up (2006-2016) was performed in 745 participants. GFR was evaluated through the MDRD formula. Heart failure phenotype was defined according to baseline ejection fraction (EF); heart failure with reduced EF (i.e. <40%) (HFrEF), preserved EF (i.e ≥50%) (HFpEF) and mid-range EF (i.e. 40-49%) (HFmrEF).
Results: 10y ACS mortality was 21%. Patients who suffered from a new fatal episode within the decade had significantly lower GFR and higher BNP values at baseline, compared with their alive counterparts (all ps<0.001). In multivariate logistic regression analysis, GFR remained an independent predictor for the incidence of ACS death within the decade, after adjusting for potential confounders (OR=0.98 95%CI (0.97, 1.00), p=0.04). Additionally, since BNP levels were strongly associated with both the primary outcome and the GFR (p<0.001 from Spearman's correlation test), BNP was forced included in the multivariable model as a covariate with possible mediating effect. After adjusting for baseline BNP, GFR lost its significance whilst BNP levels (expressed per 2 fold increase) independently predicted ACS mortality (OR=1.39 95%CI (1.15, 1.67), p=0.001). What is more a significant interaction was observed between EF and BNP levels on the tested outcome (p for interaction<0.001). In stratified analysis the aforementioned significant predictive value of BNP retained only in HFmrEF (OR=1.43 95%CI (1.01, 2.03), p=0.04) and in HFpEF (OR=1.80 95%CI (1.15, 2.82), p=0.01).
Conclusion: BNP values were highlighted as an important predictor in long term prognosis of coronary patients with heart failure, namely those with better performance of left ventricle for whom further investigation is highly demanded.
Keywords:
ACS,Renal failure,BNP levels,Cardiac failure,Long-term prognosis.
