NT-proBNP, IGF-I and survival in patients with chronic heart failure

Objective: Growth hormone (GH) resistance with a reduction of insulin-like growth factor-I (IGF-I) serum concentrations seems to be implicated in the catabolic process associated with chronic heart failure (CHF). However, data concerning the prognostic value of these alterations in CHF patients without cachexia are scant. In this study, we aimed to determine in CHF patients the prognostic value of IGF-I/GH ratio and its relationships with N-terminal brain natriuretic peptide (NT-proBNP), a known marker of prognosis in these patients. Design: We enrolled 82 non-cachectic patients, mean age 61 ± 13 years, with ejection fraction <40% and predischarge New York Heart Association (NYHA) functional classes II-IV. All patients underwent clinical examination, two-dimensional echocardiography and NT-proBNP, GH and IGF-I measurement with log IGF-I/GH ratio calculation. Mortality and clinical status was documented at follow-up (18.4 ± 8.1 months). Results: During follow-up 17 patients died of cardiac causes. Non-survivors were at baseline in higher NYHA class (P < 0.05) and showed higher values of NT-proBNP (P < 0.001) than survivors; differently IGF-I, and log IGF-I/GH ratio were lower (P < 0.05). At Cox multivariate analysis, NT-proBNP (P < 0.001) and IGF-I/GH ratio (P < 0.05) were independent predictors of death. Conclusions: High NT-proBNP levels and low IGH-I/GH ratio may be useful to stratify CHF patients at higher risk of cardiac death.