Skip to main content
SpringerLink
Log in

Clinical and echocardiographic characteristics of elderly hospitalized patients with high levels of NT-proBNP without clinical diagnosis of heart failure

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Patients with high NT-proBNP levels but without heart failure (HF) diagnosis have a higher risk of cardiovascular events and mortality; however, there are few data about their characteristic, especially in the elderly.

Aims

To compare the clinical and echocardiographic characteristics of elderly hospitalized patients with and without increased NT-proBNP and with and without a diagnosis of HF.

Methods

We reviewed 209 charts of patients admitted to an acute care ward (mean age 78.9 years, SD 10.2, 62 % women). We classified the patients into four groups: no HF with or without increased (>900 pg/mL) NT-proBNP (HF−/BNP−, N = 89 and HF−/BNP+, N = 41), and HF with or without increased NT-proBNP (HF+/BNP−, N = 4 and HF+/BNP+, N = 75). The groups were compared with respect to demographic and clinical characteristics, symptoms at admission, comorbidities, echocardiographic parameters, and cardiovascular events at 180 days.

Results

Patients in the groups HF+/BNP+ and HF−/BNP+ were older, with higher serum creatinine, blood urea nitrogen, and lower serum hemoglobin compared to patients in the HF−/BNP− group. The prevalence of ischemic heart disease, pulmonary hypertension, and atrial fibrillation progressively decreased across the HF+/BNP+, HF−/BNP+, and HF−/BNP− groups. The prevalence of abnormal echocardiographic findings in the HF−/BNP+ group was intermediate compared to the other two groups for severe aortic or mitralic regurgitation, monophasic transmitralic pattern, biatrial atriomegaly, ejection fraction, akinesia extension, and PAPs. The same pattern was observed for cardiovascular events at follow-up.

Discussion

Elderly patients without a diagnosis of HF, but with high NT-proBNP serum concentration have intermediate clinical characteristics compared to the other two groups.

Conclusion

NT-proBNP may be a useful marker of silent cardiac damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kannel WB (1999) Current status of the epidemiology of heart failure. Curr Cardiol Rep 1:11–19

    Article  CAS  PubMed  Google Scholar 

  2. Yousaf F, Collerton J, Kingston A, Kenny A, Davies K, Jagger C, Robinson L, Kirkwood TBL, Keavney B (2012) Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study. Heart Br Card Soc 98:1418–1423. doi:10.1136/heartjnl-2012-302457

    Article  Google Scholar 

  3. Hobbs FDR, Kenkre JE, Roalfe AK, Davis RC, Hare R, Davies MK (2002) Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. Eur Heart J 23:1867–1876

    Article  CAS  PubMed  Google Scholar 

  4. Masoudi FA, Rumsfeld JS, Havranek EP, House JA, Peterson ED, Krumholz HM, Spertus JA (2004) Age, functional capacity, and health-related quality of life in patients with heart failure. J Card Fail 10:368–373

    Article  PubMed  Google Scholar 

  5. Massie BM, Shah NB (1997) Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J 133:703–712

    Article  CAS  PubMed  Google Scholar 

  6. Masoudi FA, Havranek EP, Krumholz HM (2002) The burden of chronic congestive heart failure in older persons: magnitude and implications for policy and research. Heart Fail Rev 7:9–16

    Article  PubMed  Google Scholar 

  7. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2005) ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the heart rhythm society. Circulation 112:154–235. doi:10.1161/CIRCULATIONAHA.105.167586

    Article  Google Scholar 

  8. McGrath MF, de Bold MLK, de Bold AJ (2005) The endocrine function of the heart. Trends Endocrinol Metab TEM 16:469–477. doi:10.1016/j.tem.2005.10.007

    Article  CAS  Google Scholar 

  9. McKie PM, Cataliotti A, Sangaralingham SJ, Ichiki T, Cannone V, Bailey KR, Redfield MM, Rodeheffer RJ, Burnett JC Jr (2011) Predictive utility of atrial, N-terminal pro-atrial, and N-terminal pro-B-type natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study. Mayo Clin Proc Mayo Clin 86:1154–1160. doi:10.4065/mcp.2011.0437

    Article  CAS  Google Scholar 

  10. deFilippi CR, Christenson RH, Gottdiener JS, Kop WJ, Seliger SL (2010) Dynamic cardiovascular risk assessment in elderly people. The role of repeated N-terminal pro-B-type natriuretic peptide testing. J Am Coll Cardiol 55:441–450. doi:10.1016/j.jacc.2009.07.069

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Oudejans I, Mosterd A, Bloemen JA, Valk MJ, van Velzen E, Wielders JP, Zuithoff NP, Rutten FH, Hoes AW (2011) Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests. Eur J Heart Fail 13:518–527. doi:10.1093/eurjhf/hfr021

    Article  PubMed  Google Scholar 

  12. Frankenstein L, Clark AL, Goode K, Ingle L, Remppis A, Schellberg D, Grabs F, Nelles M, Cleland JGF, Katus HA, Zugck C (2009) The prognostic value of individual NT-proBNP values in chronic heart failure does not change with advancing age. Heart Br Card Soc 95:825–829. doi:10.1136/hrt.2008.158626

    Article  CAS  Google Scholar 

  13. Cleland JGF, Taylor J, Freemantle N, Goode KM, Rigby AS, Tendera M (2012) Relationship between plasma concentrations of N-terminal pro brain natriuretic peptide and the characteristics and outcome of patients with a clinical diagnosis of diastolic heart failure: a report from the PEP-CHF study. Eur J Heart Fail 14:487–494. doi:10.1093/eurjhf/hfs049

    Article  CAS  PubMed  Google Scholar 

  14. Hinderliter AL, Blumenthal JA, O’Conner C, Adams KF, Dupree CS, Waugh RA, Bensimhon D, Christenson RH, Sherwood A (2008) Independent prognostic value of echocardiography and N-terminal pro-B-type natriuretic peptide in patients with heart failure. Am Heart J 156:1191–1195. doi:10.1016/j.ahj.2008.07.022

    Article  PubMed Central  PubMed  Google Scholar 

  15. Raymond I, Groenning BA, Hildebrandt PR, Nilsson JC, Baumann M, Trawinski J, Pedersen F (2003) The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart Br Card Soc 89:745–751

    Article  CAS  Google Scholar 

  16. Costello-Boerrigter LC, Boerrigter G, Redfield MM, Rodeheffer RJ, Urban LH, Mahoney DW, Jacobsen SJ, Heublein DM, Burnett JC Jr (2006) Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction. J Am Coll Cardiol 47:345–353. doi:10.1016/j.jacc.2005.09.025

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Lien CTC, Gillespie ND, Struthers AD, McMurdo MET (2002) Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 4:91–98

    Article  PubMed  Google Scholar 

  18. DeFilippi C, van Kimmenade RRJ, Pinto YM (2008) Amino-terminal pro-B-type natriuretic peptide testing in renal disease. Am J Cardiol 101:82–88. doi:10.1016/j.amjcard.2007.11.029

    Article  PubMed  Google Scholar 

  19. Manzano L, Escobar C, Cleland JGF, Flather M (2012) Diagnosis of elderly patients with heart failure. Eur J Heart Fail 14:1097–1103. doi:10.1093/eurjhf/hfs109

    Article  PubMed  Google Scholar 

  20. Zaphiriou A, Robb S, Murray-Thomas T, Mendez G, Fox K, McDonagh T, Hardman SMC, Dargie HJ, Cowie MR (2005) The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study. Eur J Heart Fail 7:537–541. doi:10.1016/j.ejheart.2005.01.022

    Article  CAS  PubMed  Google Scholar 

  21. Januzzi JL Jr, Camargo CA, Anwaruddin S, Baggish AL, Chen AA, Krauser DG, Tung R, Cameron R, Nagurney JT, Chae CU, Lloyd-Jones DM, Brown DF, Foran-Melanson S, Sluss PM, Lee-Lewandrowski E, Lewandrowski KB (2005) The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol 95:948–954. doi:10.1016/j.amjcard.2004.12.032

    Article  CAS  PubMed  Google Scholar 

  22. Nadir MA, Rekhraj S, Wei L, Lim TK, Davidson J, MacDonald TM, Lang CC, Dow E, Struthers AD (2012) Improving the primary prevention of cardiovascular events by using biomarkers to identify individuals with silent heart disease. J Am Coll Cardiol 60:960–968. doi:10.1016/j.jacc.2012.04.049

    Article  PubMed  Google Scholar 

  23. Kalogeropoulos AP, Georgiopoulou VV, deFilippi CR, Gottdiener JS, Butler J (2012) Echocardiography, natriuretic peptides, and risk for incident heart failure in older adults: the cardiovascular health study. JACC Cardiovasc Imaging 5:131–140. doi:10.1016/j.jcmg.2011.11.011

    Article  PubMed Central  PubMed  Google Scholar 

  24. Carlsen CM, Bay M, Kirk V, Gøtze JP, Køber L, Nielsen OW (2012) Prevalence and prognosis of heart failure with preserved ejection fraction and elevated N-terminal pro brain natriuretic peptide: a 10-year analysis from the Copenhagen Hospital heart failure study. Eur J Heart Fail 14:240–247. doi:10.1093/eurjhf/hfs003

    Article  CAS  PubMed  Google Scholar 

  25. Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Omland T, Wolf PA, Vasan RS (2004) Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 350:655–663. doi:10.1056/NEJMoa031994

    Article  CAS  PubMed  Google Scholar 

  26. Murtagh G, Dawkins IR, O’Connell R, Badabhagni M, Patel A, Tallon E, O’Hanlon R, Ledwidge MT, McDonald KM (2012) Screening to prevent heart failure (STOP-HF): expanding the focus beyond asymptomatic left ventricular systolic dysfunction. Eur J Heart Fail 14:480–486. doi:10.1093/eurjhf/hfs030

    Article  CAS  PubMed  Google Scholar 

  27. deFilippi CR, Christenson RH, Kop WJ, Gottdiener JS, Zhan M, Seliger SL (2011) Left ventricular ejection fraction assessment in older adults: an adjunct to natriuretic peptide testing to identify risk of new-onset heart failure and cardiovascular death? J Am Coll Cardiol 58:1497–1506. doi:10.1016/j.jacc.2011.06.042

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interests

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Unit of Geriatrics, Area di Geriatria, Università Campus Biomedico di Roma, via Alvaro del Portillo 200, 00128, Rome, Italy

    D. Lelli, C. Pedone, F. F. Rossi & R. Antonelli Incalzi

  2. Fondazione Alberto Sordi, Rome, Italy

    C. Pedone

  3. Fondazione “San Raffaele-Cittadella della Carità”, Taranto, Italy

    R. Antonelli Incalzi

Authors
  1. D. Lelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Pedone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. F. Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Antonelli Incalzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Lelli.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lelli, D., Pedone, C., Rossi, F.F. et al. Clinical and echocardiographic characteristics of elderly hospitalized patients with high levels of NT-proBNP without clinical diagnosis of heart failure. Aging Clin Exp Res 26, 607–613 (2014). https://doi.org/10.1007/s40520-014-0226-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-014-0226-y

Keywords

Search

Navigation