Natriuretic peptide system is not exhausted in severe heart failure.

Objective: We aimed to investigate the prognostic value of amino-terminal B-type natriuretic peptide (NT-pro-BNP) in severe heart failure.

Methods: We retrospectively assessed 133 patients admitted to the hospital for decompensated heart failure, in New York Heart Association class III or IV, with depressed left ventricular ejection fraction and an NT-pro-BNP measurement within 24 h of admission. Patients were followed up for 6 months.

Results: Patients' mean age was 71.2 years; 52.6% were men; 45.9% had severe systolic dysfunction and etiology was ischemic in 56.4%. Thirty- three (24.8%) patients died during follow-up. A forward stepwise Cox regression analysis showed a multivariate-adjusted positive impact of high NT-pro-BNP levels on mortality. Patients in the third NT-pro-BNP tertile (>11378 pg/ml) had a hazard ratio of death of 5.34 [95% confidence interval (CI) 1.65-16.24] when compared with those in the first tertile (<4990 mg/l).

Conclusion: We conclude that in patients with severe heart failure, NT-pro-BNP has a powerful prognostic value. Patients with high NT-pro-BNP had more than five-fold increase in the 6-month risk of death. Our results do not support the hypothesis that ventricular exhaustion with inability to synthesize and secrete natriuretic peptides is the mechanism underlying decompensation. Attenuation mechanisms of compensatory systems ought to be further studied.