Association of change in 5-year N-terminal fragment of the prohormone brain-type natriuretic peptide with left ventricular structure and function in stable coronary disease.

AIMS: We sought to characterize the association between long-term changes in the N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) and changes in left ventricular (LV) structure and function in patients with stable coronary artery disease.

METHODS: We included 593 participants without significant valvular disease enrolled in the Heart and Soul Study. We evaluated the association of 5-year change in NT-proBNP (ΔNT-proBNP) with changes in echocardiography-determined LV ejection fraction (LVEF), LV systolic dysfunction (LVSD; LVEF < 50%), LV mass index, incident LV hypertrophy (LVH) (LV mass index >102 g/m for men and >88 g/m for women), and LV diastolic dysfunction (LVDD) using linear and logistic regression.

RESULTS: Over 5 years, the prevalence of LVH declined from 36 to 32% (P < 0.001), the prevalence of LVDD increased from 11 to 14% (P = 0.035), mean LVEF decreased from 63 ± 9% to 62 ± 10% (P = 0.07), and the prevalence of LVSD increased from 9 to 11% (P = 0.12). Compared with the lowest ΔNT-proBNP quartile (≥8 ng/l decrease) the highest quartile (>218 ng/l increase) had significantly more incident LVH and LVSD (P < 0.001 for both), with a trend toward increased incidence of LVDD. In logistic regression models adjusted for demographics, cardiac comorbidities, baseline LV structure and function, medication use, kidney function, and baseline NT-proBNP, log-transformed ΔNT-proBNP was associated only with incident LVSD (odds ratio 2.48 × 10, 95% confidence interval 224.53-2.73 × 10, P = 0.002).

CONCLUSION: A ΔNT-proBNP is independently associated with incident LVSD in patients with stable coronary artery disease. This suggests that a long-term rise in NT-proBNP levels may warrant evaluation for incident LVEF less than 50%.