Prognostic Value of Combined Measurement of Brain Natriuretic Peptide and Triiodothyronine in Heart Failure

Abstract: Background: Both low free-triiodothyronine (fT3) and high brain natriuretic peptide (BNP) have been separately described as prognostic predictors for mortality in heart failure (HF). We investigated whether their prognostic value is independent. Methods and results: From January 2001 to December 2006 we prospectively evaluated 442 consecutive patients with systolic HF and no thyroid disease or treatment with drugs affecting thyroid function (age 65±12 yrs, mean±SD, males 75%, left ventricular ejection fraction - EF 33±10 %, NYHA class I-II: 63%, III-IV: 37%). All patients underwent full clinical and echocardiographic evaluation, and assessment of BNP and thyroid function. Both cardiac and all-cause mortality (cumulative) were considered as end-points. Over a median 36-month follow-up (range 1-86), 110 (24.8%) patients died, 64 (14.4%) for cardiac causes. Univariate Cox model predictors of all-cause and cardiac death resulted age, body mass index, creatinine, hemoglobin, EF, NYHA class, BNP, fT3 and thyroxine level. Furthermore, multivariate analysis selected age, NYHA class, hemoglobin, BNP and fT3 as independent predictors for all-cause mortality, while NYHA class, BNP and fT3 for cardiac mortality. Patients with low fT3 and higher BNP showed the highest risk of all-cause and cardiac death (odds ratio was 11.6, C.I. 5.8-22.9 and 13.8, C.I. 5.4-35.2, respectively, as compared to patients with normal fT3 and low BNP).