Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: We agree with Dr Schelbert that a critical evaluation of any new clinical application of an established or novel biomarker must include appraisal of whether it provides information that is incremental to that obtained during usual clinical care. We found that after accounting for the patients' age, sex, vascular risk factors, severity of the initial coronary syndrome, electrocardiographic findings, renal function, and clinical examination for evidence of heart failure, BNP showed a strong independent association with the risk of future heart failure or death in patients who returned for follow-up free of cardiac complications. In addition, either new elevation of BNP or return of BNP to low levels offered additional information with respect to the patients' long-term risk of death or new heart failure. It is on the basis of these observations that we conclude that changes in BNP are associated with long-term outcomes, and by providing additional data regarding the patient's risk may enable the clinician to make better-informed decisions regarding secondary preventive interventions.
Morrow DA. Prognostic Value of B-Type Natriuretic Peptide in Unstable Coronary Artery Disease—Reply. JAMA. 2006;295(16):1895–1896. doi:10.1001/jama.295.16.1895-b
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