• Gianluigi Savarese, Francesca Musella, Carmen D'Amore, Enrico Vassallo, Teresa Losco, Francesco Gambardella, Milena Cecere, Laura Petraglia, Gennaro Pagano, Luigi Fimiani, Giuseppe Rengo, Dario Leosco, Bruno Trimarco, and Pasquale Perrone-Filardi.
• Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
• JACC Heart Fail. 2014 Apr 1;2(2):148-58.

ObjectivesThe goal of this study was to explore the association between changes in B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma levels and risk of hospital admission for heart failure (HF) worsening in patients with chronic HF.BackgroundThe relationship between BNP and NT-proBNP plasma levels and risk of cardiovascular events in patients with chronic HF has been previously demonstrated. However, it is unclear whether changes in BNP and NT-proBNP levels predict morbidity in patients with chronic HF.MethodsThe MEDLINE, Cochrane, ISI Web of Science, and SCOPUS databases were searched for papers about HF treatment up to August 2013. Randomized trials enrolling patients with systolic HF, assessing BNP and/or NT-proBNP at baseline and at end of follow-up, and reporting hospital stay for HF were included in the analysis. Meta-regression analysis was performed to test the relationship between BNP and NT-proBNP changes and the clinical endpoint. Sensitivity analysis was performed to assess the influence of baseline variables on results. Egger's linear regression was used to assess publication bias.ResultsNineteen trials enrolling 12,891 participants were included. The median follow-up was 9.5 months (interquartile range: 6 to 18 months), and 22% of patients were women. Active treatments significantly reduced the risk of hospital stay for HF worsening. In meta-regression analysis, changes in BNP and NT-proBNP were significantly associated with risk of hospital stay for HF worsening. Results were confirmed by using sensitivity analysis. No publication bias was detected.ConclusionsIn patients with HF, reduction of BNP or NT-proBNP levels was associated with reduced risk of hospital stay for HF worsening.Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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