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

• Published in: Heart (British Cardiac Society) Vol. 105; no. 15; pp. 1182 - 1189
• Main Authors: Salah, Khibar, Stienen, Susan, Pinto, Yigal M, Eurlings, Luc W, Metra, Marco, Bayes-Genis, Antoni, Verdiani, Valerio, Tijssen, Jan G P, Kok, Wouter E
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.08.2019; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research article
• Subjects: acute decompensated Heart failure; Ejection fraction; Heart failure; Heart Failure and Cardiomyopathies; Medical prognosis; Mortality; NT-proBNP; Peptides; Population; preserved left ventricle ejection fraction; prognosis; Regression analysis; Statistical analysis; acute decompensated Heart failure; preserved left ventricle ejection fraction; NT-proBNP; prognosis
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2018-314173

BackgroundWe 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).MethodsPatients 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.ResultsDischarge 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.ConclusionsOur 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.