ORIGINAL ARTICLE  PERIPHERAL ARTERIAL DISEASE Free access

International Angiology 2021 December;40(6):520-7

DOI: 10.23736/S0392-9590.21.04720-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Impact of brain natriuretic peptide for predicting long-term life expectancy and cardiovascular or limb events in peripheral arterial disease

Kuniki NAKASHIMA ¹, Hisao KUMAKURA ² ✉, Ryuichi FUNADA ², Yae MATSUO ², Kimimasa SAKATA ¹, Akiko ICHIKAWA ³, Toshiya IWASAKI ², Shuichi ICHIKAWA ²

¹ Department of Cardiovascular Surgery, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Japan; ² Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Japan; ³ Department of Nephrology, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Japan

BACKGROUND: Brain natriuretic peptide (BNP) is introduced as a predictor of the degree of ventricular dysfunction and is associated with mortality. There are limited reports on the relationship of BNP with long-term all-cause death (AD) and cardiovascular or limb events in peripheral artery disease (PAD). We examined the relationship between BNP level and these events in PAD patients.
METHODS: We performed a prospective cohort study in 938 PAD patients. The patients were divided into four groups based on BNP levels with median (interquartile range): Q1: ≤20.4; Q2: 20.5-42.8; Q3: 42.9-103.4; and Q4: ≥103.5 pg/mL. The endpoints were AD, freedom from major adverse cardiovascular events (MACE), and MACE plus limb events (MALE).
RESULTS: The median follow-up time was 65 months. There were 383 deaths (40.8%) during follow-up period. AD depended on BNP levels (P<0.01), with 5-year freedom from AD rates of Q1: 94%, Q2: 84%, Q3: 69%, and Q4: 55%. The Kaplan-Meier estimates of freedom from AD, MACE, and MALE had significant differences among Q1- Q4 groups (P<0.001). In multiple regression analysis, BNP had significant negative correlations with eGFR, serum albumin, and BMI and positive correlations with diabetes (P<0.05). In Cox multivariate analysis, higher BNP, age, CRP, D-dimer, lower BMI, ABI, serum albumin, and eGFR were related to AD; and higher BNP, age, lower ABI, serum albumin, CAD, and DM were related to MACE and MALE (P<0.05). Statins improved AD, MACE, and MALE (P<0.01).
CONCLUSIONS: BNP was a promising biomarker for AD, MACE, and MALE in patients with PAD.

KEY WORDS: Mortality; Brain natriuretic peptide; Peripheral arterial disease