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Factors Associated With Elevated N-Terminal Pro B-Type Natriuretic Peptide Concentrations at the Convalescent Stage

Bolrathanak Oeun1, Daisaku Nakatani1, Shungo Hikoso1

  • 1Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan.

Circulation Reports
|March 11, 2021
PubMed

Insights

Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) in heart failure with preserved ejection fraction (HFpEF) patients is linked to malnutrition, kidney issues, inflammation, and atrial fibrillation. These factors predict worse outcomes and higher mortality rates.

Area of Science:

  • Cardiology
  • Biomarkers
  • Clinical Outcomes

Background:

  • N-terminal pro B-type natriuretic peptide (NT-proBNP) is a key biomarker in heart failure.
  • Factors influencing elevated NT-proBNP and their prognostic implications in heart failure with preserved ejection fraction (HFpEF) during convalescence remain unclear.

Purpose of the Study:

  • To identify factors associated with elevated NT-proBNP at the convalescent stage in HFpEF patients.
  • To evaluate the impact of these factors on 1-year clinical outcomes, including mortality and rehospitalization.

Main Methods:

  • A cohort of 469 HFpEF patients was analyzed.
  • Elevated NT-proBNP was defined as the highest quartile (Q4) of concentrations.
  • Multivariate logistic regression identified associated factors: low albumin, low estimated glomerular filtration rate (eGFR), high C-reactive protein (CRP), and atrial fibrillation at discharge.

Main Results:

  • Low albumin (OR 2.44), low eGFR (OR 5.83), high CRP (OR 2.09), and atrial fibrillation (OR 2.33) were significantly associated with elevated NT-proBNP.
  • Patients in the highest NT-proBNP quartile (Q4) had significantly higher rates of all-cause mortality and HF rehospitalization (P<0.001).
  • The risk of adverse events increased proportionally with the number of associated factors present.

Conclusions:

  • Extracardiac factors like malnutrition, renal impairment, and inflammation, along with atrial fibrillation, are associated with elevated NT-proBNP in convalescent HFpEF patients.
  • These factors contribute to a poor prognosis, characterized by increased mortality and heart failure rehospitalization.
  • Targeting these modifiable factors may improve outcomes for HFpEF patients with elevated NT-proBNP.

Keywords:
Heart failure with preserved ejection fraction (HFpEF)N-terminal pro B-type natriuretic peptide (NT-proBNP)Prognosis

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