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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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NT-proBNP and its correlation to left ventricular ejection fraction and heart failure - The DEMONSTRATE database
Morgan Lundgren1, Peter Ridefelt1, Maria K Svensson2,3
1Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
Annals of Clinical Biochemistry
|November 17, 2025
Summary
N-terminal pro-B-type natriuretic peptide (NT-proBNP) increases as left ventricular ejection fraction (LVEF) declines in heart failure (HF) patients. NT-proBNP shows potential as a complementary tool for assessing cardiac function.
Area of Science:
- Cardiology
- Biomarker Research
- Diagnostic Medicine
Background:
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) are key diagnostics for heart failure (HF).
- Understanding the correlation between NT-proBNP and LVEF is crucial for refining HF diagnosis and management.
Purpose of the Study:
- To investigate the correlation between NT-proBNP levels and LVEF across different HF phenotypes.
- To evaluate the diagnostic and prognostic utility of NT-proBNP in comparison to LVEF for heart failure.
Main Methods:
- Analysis of data from 14,962 patients from the Swedish DEMONSTRATE database.
- Categorization of HF phenotypes: HFrEF (≤40%), HFmrEF (41-49%), HFpEF (≥50%).
- Spearman's rank correlation and ROC curve analysis were used to assess relationships and discriminatory power.
Main Results:
- A significant negative correlation was found between NT-proBNP and LVEF (r = -0.40), persisting after adjustment for age and kidney function (r = -0.20).
- NT-proBNP demonstrated strong discrimination for HFrEF (AUC = 0.80) and HFpEF (AUC = 0.78).
- NT-proBNP (AUC = 0.81) outperformed LVEF (AUC = 0.75) in discriminating the presence of an HF diagnosis, despite a modest individual-level correlation.
Conclusions:
- NT-proBNP levels rise with decreasing LVEF, but with considerable inter-individual variability.
- Sequential NT-proBNP analysis may optimize LVEF assessment, serving as a complementary diagnostic and prognostic tool in heart failure.
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