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Prognostic Value of B-Type Natriuretic Peptide in Unstable Coronary Artery Disease
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To the Editor: Dr Morrow and colleagues1 studied the prognostic value of serial testing of B-type natriuretic peptide (BNP) in patients with unstable coronary artery disease. I am not certain of the validity of their conclusion that changes in BNP levels are associated with long-term clinical outcomes and may provide enhanced decision making in these patients.
A crucial issue is whether BNP measurement provides important incremental prognostic information beyond that available to a clinician from a patient interview, such as an assessment of health status (symptoms, functional status, and quality of life). Level of BNP could be little more than a costly surrogate measure of health status that merely identifies those with a greater burden of heart disease. This cannot be determined from this article because the results were not adjusted for health status.
Level of BNP is correlated with health status,2 and health status3-4 and BNP1 have been separately . . . [Full Text of this Article]
Erik Schelbert, MD
erik-schelbert@uiowa.edu
Division of Cardiovascular Diseases
University of Iowa
Iowa City
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