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. 2019 Aug;105(15):1182-1189.
doi: 10.1136/heartjnl-2018-314173. Epub 2019 Apr 8.

Prognosis and NT-proBNP in heart failure patients with preserved versus reduced ejection fraction

Khibar Salah  1   2 , Susan Stienen  1   3 , Yigal M Pinto  1 , Luc W Eurlings  4 , Marco Metra  5 , Antoni Bayes-Genis  6 , Valerio Verdiani  7 , Jan G P Tijssen  1 , Wouter E Kok  1
Affiliations

Prognosis and NT-proBNP in heart failure patients with preserved versus reduced ejection fraction

Khibar Salah et al. Heart. 2019 Aug.

Abstract

Background: We assessed the prognostic significance of absolute and percentage change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients hospitalised for acute decompensated heart failure with preservedejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF).

Methods: Patients with left ventricular ejection fraction ≥50% were categorised as HFpEF (n=283), while those with <40% as were categorised as HFrEF (n=776). Prognostic values of absolute and percentage change in NT-proBNP levels for 6 months all-cause mortality after discharge were assessed separately in patients with HFpEF and HFrEF by multivariable adjusted Cox regression analysis. Comorbidities were compared between heart failure groups.

Results: Discharge NT-proBNP levels predicted outcome similarly in HFpEF and HFrEF: for any 2.7-factor increase in NT-proBNP levels, the HR for mortality was 2.14 for HFpEF (95% CI 1.48 to 3.09) and 1.96 for HFrEF (95% CI 1.60 to 2.40). Mortality prediction was equally possible for NT-proBNP reduction of ≤30% (HR 4.60, 95% CI 1.47 to 14.40 and HR 3.36, 95% CI 1.93 to 5.85 for HFpEF and HFrEF, respectively) and for >30%-60% (HR 3.28, 95% CI 1.07 to 10.12 and HR 1.79, 95% CI 0.99 to 3.26, respectively), compared with mortality in the reference groups of >60% reductions in NT-proBNP levels. Prognostically relevant comorbidities were more often present in patients with HFpEF than patients with HFrEF in low (≤3000 pg/mL) but not in high (>3000 pg/mL) NT-proBNP discharge categories.

Conclusions: Our study highlights-after demonstrating that NT-proBNP levels confer the same relative risk information in HFpEF as in HFrEF-the possibility that comorbidities contribute relatively more to prognosis in patients with HFpEF with lower NT-proBNP levels than in patients with HFrEF.

Keywords: NT-proBNP; acute decompensated Heart failure; preserved left ventricle ejection fraction; prognosis.

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Conflict of interest statement

Competing interests: YMP is a recipient of payments for lectures including service on speakers’ bureaus and research grants from Roche Diagnostics. YMP has an unrelated biomarker patent and stocks in a university spinoff company. WEK received a grant (2010B97) from the Dutch Heart Foundation for the PRIMA II study and has participated in advisory board meetings of Roche Diagnostics and Novartis. MM is a member of the board in Corthera and Novartis and receives payment for lectures including service on speakers’ bureaus from Servier or Stroder.

Figures

Figure 1
Figure 1
Relationship between 6-month all-cause mortality and the three types of heart failure adjusted for age ≥75 years, peripheral edema at admission, systolic blood pressure (SBP) <115 mm Hg, hyponatraemia (sodium levels <135 mmol/L) and serum urea levels ≥15 mmol/L. HFmrEF, heart failure with mid range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 2
Figure 2
Relationship between 6-month all-cause mortality and the four categories of admission and discharge NT-proBNP levels as well as for the categories of percentage reduction during hospitalisation according to the types of HF. HF, heart failure; HFmrEF, heart failure with midrange ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction NT-proBNP, N-terminal pro-B-type natriuretic peptide.
See this image and copyright information in PMC

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