B-Type Natriuretic Peptide and Prognosis in Heart Failure Patients With Preserved and Reduced Ejection Fraction

Study Questions:

What is the prognostic value of B-type natriuretic peptide (BNP) in patients with heart failure with preserved ejection fraction (HFPEF), in comparison to that in patients with reduced left ventricular (LV) EF (≤40%)?

Methods:

This was an 18-month prospective cohort analysis of patients (n = 615) with New York Heart Association (NYHA) functional class II-IV heart failure participating in the COACH (Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) trial. COACH was a randomized trial to evaluate the effect of two levels of a disease management program versus usual care. In this trial, patients were randomized before discharge at the end of a hospitalization for HF. A single BNP measurement was taken at this time. The primary outcome was a composite of hospitalization for HF or all-cause mortality.

Results:

BNP levels were significantly higher in patients with reduced LVEF than in those with HFPEF (p < 0.001). Among patients with an LVEF >50% (n = 74), the mean BNP level was 256 pg/ml (112-598 pg/ml), compared to 534 pg/ml (275-1130 pg/ml) in those with an LVEF ≤20%. BNP was a strong predictor for outcome, both in the whole population, as well as in the two subgroups of patients with LVEF ≤40% and in those with LVEF >40%.

Conclusions:

The authors concluded that BNP levels in patients with HPFEF are lower than in those with reduced LVEF, but are still predictive of prognosis.

Perspective:

While limited by a small size (especially in the subset of patients with an LVEF ≤40%, which the authors defined as PEF), the current analysis indicates that the prognosis in patients with HFPEF is similar as in those with reduced LVEF, for a given BNP level. Although future research is needed and there are still no proven therapies for the growing problem of HFPEF, this analysis would at least suggest that BNP can be used to guide prognosis in everyday clinical practice and in conduct of clinical trials, irrespective of LVEF.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Prognosis, Natriuretic Peptides, Biological Markers, Troponin I, Heart Failure


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