Role of NT-proBNP Levels in Patients With HFpEF | Journal Scan

Jun 02, 2015
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Authors:
Kristensen SL, Jhund PS, Køber L, et al.
Citation:
Relative Importance of History of Heart Failure Hospitalization and N-Terminal Pro–B-Type Natriuretic Peptide Level as Predictors of Outcomes in Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail 2015;3:478-486.
Summary By:
Reema Hasan, MD, FACC

Study Questions:

Can N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels predict future events in patients with hospitalized heart failure with preserved ejection fraction (HFpEF)?

Methods:

Clinical outcomes of HF hospitalization and cardiovascular (CV) death according to baseline NT-proBNP were analyzed in patients with New York Heart Association (NYHA) class III-IV symptoms from the I-PRESERVE (Irbesartan in Heart Failure With Preserved Systolic Function) study. This trial enrolled 4,028 patients with left ventricular EF of at least 45% who were 60 years of age and older and had HF symptoms with NYHA class II-IV. NT-proBNP was measured in these patients at baseline. The composite outcome studied was CV death or HF hospitalization (and each separately).

Results:

About 29% of patients enrolled had a history of recent HF hospitalization, of which their median level of NT-proBNP was significantly higher compared to those with no recent HF hospitalization (609 vs. 254 pg/ml). Baseline NT-proBNP was >360 pg/ml in 47% of patients. These patients were older, more likely to be male, and had lower estimated glomerular filtration rate (63 vs. 74 L/min/1.73 m2). They also were more likely to have ischemic heart disease (31% vs. 22%) and had four-fold higher prevalence of atrial fibrillation compared to patients with NT-proBNP ≤360 pg/ml. Patients with a NT-proBNP level >360pg/ml were 3 times more likely to experience composite outcomes of CV death and HF hospitalization compared to patients with a NT-proBNP level ≤360 pg/ml (95% confidence interval [CI], 2.68-3.71; p < 0.001). Rates of composite endpoints for patients with NT-proBNP >360 pg/ml were 11.51 (95% CI, 10.54-12.58) compared to 3.04 (95% CI, 2.63-3.52) per 100 person-years with a lower level of NT-proBNP (hazard ratio,3.19; 95% CI, 2.68-3.08).

Conclusions:

In this trial, elevated natriuretic peptide level and a history of recent hospitalization identified patients at higher risk for HF hospitalization, CV death, and the composite of both outcomes.

Perspective:

For future trials in patients with HFpEF, a recent hospitalization and higher NT-proBNP levels can be used to help identify potential high-risk patients.

Keywords: Atrial Fibrillation, Biphenyl Compounds, Glomerular Filtration Rate, Heart Failure, Hospitalization, Mortality, Myocardial Ischemia, Natriuretic Peptide, Brain, Natriuretic Peptides, Peptide Fragments, Prevalence, Tetrazoles


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