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Comparable prognostic impact of BNP levels among HFpEF, Borderline HFpEF and HFrEF: a report from the CHART-2 Study

Shintaro Kasahara1, Yasuhiko Sakata2, Kotaro Nochioka1

  • 1Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.

Heart and Vessels
|March 24, 2018
PubMed

Insights

Plasma B-type natriuretic peptide (BNP) levels effectively stratify long-term mortality risk in heart failure (HF) patients across preserved, borderline, and reduced ejection fraction groups. BNP offers comparable prognostic value regardless of heart failure type.

Area of Science:

  • Cardiology
  • Biomarkers
  • Heart Failure Research

Background:

  • Heart failure (HF) encompasses diverse patient groups based on left ventricular ejection fraction (LVEF).
  • Accurate long-term risk stratification is crucial for managing HF patients with varying LVEF.
  • Plasma B-type natriuretic peptide (BNP) is a recognized biomarker in HF, but its utility across different LVEF categories requires further comparison.

Purpose of the Study:

  • To compare the effectiveness of plasma B-type natriuretic peptide (BNP) levels for long-term risk stratification in heart failure patients with preserved (HFpEF), borderline, and reduced (HFrEF) left ventricular ejection fraction (LVEF).
  • To determine if BNP's prognostic impact varies across these distinct HF phenotypes within a single cohort.

Main Methods:

  • Analysis of 4301 consecutive Stage C/D heart failure patients from the CHART-2 Study.
  • Categorization into three groups: HFpEF (LVEF ≥ 50%), borderline HFpEF (LVEF 40-50%), and HFrEF (LVEF ≤ 40%).
  • Long-term follow-up (median 6.3 years) assessing all-cause mortality, with analysis of plasma BNP levels and their correlation with mortality risk across groups.

Main Results:

  • Median BNP levels progressively increased from HFpEF to borderline HFpEF and HFrEF (85.3, 126, and 208 pg/ml, respectively; P < 0.001).
  • The relationship between log2 BNP levels and mortality risk was comparable across all three HF groups.
  • Increasing BNP levels (30-99, 100-299, and ≥300 pg/ml) were associated with similarly increasing mortality risks in HFpEF, borderline HFpEF, and HFrEF patients (all P < 0.001).

Conclusions:

  • Plasma BNP levels demonstrate a comparable and significant prognostic impact for long-term mortality risk stratification among patients with HFpEF, borderline HFpEF, and HFrEF.
  • BNP serves as a valuable and consistent biomarker for risk assessment across the spectrum of left ventricular ejection fraction in heart failure.
  • These findings support the use of BNP as a unified tool for risk stratification in diverse heart failure populations.

Keywords:
B-type natriuretic peptideHeart failureLeft ventricular ejection fractionPrognosis

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