Comparison of novel pro-BNP _1-108 and standard BNP assays in heart failure patients

Background: Heart failure (HF) progression and outcomes reflect activation of multiple neurohormonal systems. Which biomarkers reflecting these systems contribute incremental information remains unclear. The aim of this study was to determine if serial measurements of pro-BNP _1-108 separately, in combination with standard assay BNP, or with troponin T (cTnT) would enhance risk stratification in ambulatory HF patients. Methods: A cohort of 187 Class III-IV HF patients was prospectively studied. Blood was collected every 3months over 2years for biomarker analysis [pro-BNP _1-108, standard assay BNP, troponin T (cTnT)] in relation to the primary endpoint of death or cardiac transplantation. Results: Univariate categorical and continuous variable analyses of single-sample and time-dependent serial values of pro-BNP _1-108 and BNP demonstrated that elevations in both biomarkers were associated with increased risk of death/transplantation. Multivariate analysis of serial measurements adjusted for cTnT revealed cTnT as the independent marker of risk. Combined elevations of either pro-BNP _1-108 or BNP with cTnT, however, were the most significant predictors of outcome. Conclusions: Circulating levels of pro-BNP _1-108 appear to be comparable to mature BNP in ambulatory HF out-patients. Elevated levels of pro-BNP _1-108 or BNP identified by serial monitoring similarly predict events. A strategy of serial monitoring of either pro-BNP _1-108 or BNP alone or particularly in combination with cTnT can serve a valuable role in detecting higher-risk HF patients.