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Low Natriuretic Peptide Levels and Outcomes in Patients With Heart Failure and Preserved Ejection Fraction
Toru Kondo1, Ross Campbell2, Pardeep S Jhund2
1British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Nearly a quarter of heart failure patients with preserved ejection fraction have low N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Despite a better prognosis, their health status remains impaired and requires treatment focus.
Area of Science:
- Cardiology
- Biomarkers in Heart Failure
- Clinical Trials
Background:
- Some heart failure (HF) patients with mildly reduced/preserved ejection fraction (HFpEF) exhibit low natriuretic peptide levels.
- Limited large-scale studies exist on the prevalence and outcomes of these HFpEF patients with low natriuretic peptide levels.
Purpose of the Study:
- To determine the proportion of patients in the I-PRESERVE trial with N-terminal pro-B-type natriuretic peptide (NT-proBNP) <125 pg/mL.
- To analyze the clinical characteristics and outcomes of HFpEF patients with low NT-proBNP levels.
Main Methods:
- Analysis of patients from the I-PRESERVE trial with symptomatic HF and LVEF ≥45%.
- Baseline NT-proBNP levels were measured post-enrollment.
- Primary outcome: composite of cardiovascular death or HF hospitalization.
Main Results:
- 23.2% (808/3480) of patients had NT-proBNP <125 pg/mL.
- Patients with low NT-proBNP were younger, less often male, had higher BMI, and less comorbidity (e.g., atrial fibrillation, diabetes).
- Low NT-proBNP was associated with reduced cardiovascular death/HF hospitalization risk (aHR: 0.35) but similar impaired health status.
Conclusions:
- Almost one-quarter of HFpEF patients present with low NT-proBNP levels.
- These patients have a favorable prognosis but share significantly impaired health status with higher NT-proBNP groups.
- Impaired health status in low NT-proBNP HFpEF patients warrants targeted therapeutic strategies.
Background:
Although some patients with heart failure (HF) with mildly reduced/preserved ejection fraction have low natriuretic peptide levels, there are no large-scale systematic studies of how common these individuals are or what happens to them.
Objectives:
The purpose of this study was to examine the proportion of patients in the I-PRESERVE (Irbesartan in Heart Failure with Preserved Ejection Fraction) trial with an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level <125 pg/mL, their clinical characteristics, and outcomes.
Methods:
I- PRESERVE enrolled patients with symptomatic HF and a LVEF ≥45% but who did not have NT-proBNP or body mass index inclusion/exclusion criteria. Baseline NT-proBNP was measured after enrollment but not reported to investigators. The primary outcome in this analysis was the composite of cardiovascular death or HF hospitalization.
Results:
Overall, 808 of 3,480 patients (23.2%) had NT-proBNP <125 pg/mL. Patients with a low NT-proBNP were younger (68.6 years vs 72.6 years; P < 0.001), were less often men (36.1% vs 40.9%; P = 0.015), and had a higher body mass index (48.4% vs 38.7% obese; P < 0.001) than those with a higher NT-proBNP level. Patients with a low NT-proBNP had less atrial fibrillation (8.5% vs 35.1%; P < 0.001), myocardial infarction, diabetes, chronic obstructive pulmonary disease, and anemia but better kidney function. Patients with a lower NT-proBNP level had less marked echocardiographic abnormalities and were less likely to experience cardiovascular death or HF hospitalization; adjusted HR: 0.35 (95% CI: 0.27-0.46; P < 0.001). However, health status was similarly impaired in patients with lower and higher NT-proBNP levels (median Minnesota Living with Heart Failure Questionnaire 43 vs 43; P = 0.95).
Conclusions:
Almost one-quarter of patients with HF with mildly reduced/preserved ejection fraction had a low NT-proBNP level. Although these patients have a favorable prognosis, compared to those with a high NT-proBNP level, they have similarly impaired health status which should be a target for treatment. (Irbesartan in Heart Failure With Preserved Systolic Function [I- PRESERVE]; NCT00095238).
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