Prognostic value of early changes in NT-proBNP across left ventricular ejection fraction status in acute heart...

Reductions in NT-proBNP during hospitalization for acute heart failure (AHF) are linked with improved outcomes. Whether this association holds along the entire spectrum of left ventricular ejection fraction (LVEF), particularly in patients with supranormal LVEF (≥65%), remains unclear. We aimed to evaluate whether the prognostic significance of early NT-proBNP changes varies across LVEF categories.

We included 3276 consecutive patients hospitalized for AHF across three tertiary centres. NT-proBNP was measured at admission and within 48-72 hours. The relative change (ΔNT-proBNP) was calculated, and patients were stratified into four LVEF categories: ≤40%, 41-49%, 50-64%, and ≥65%. Primary outcomes were all-cause mortality, cardiovascular death, and recurrent HF hospitalizations, analyzed using multivariable Cox and negative binomial models. The proportion of patients with LVEF ≤40%, 41%-49%, 50%-64%, and ≥65% was 36.3%, 13.3%, 31.5%, and 19.9%, respectively. Median ΔNT-proBNP was 8.8% (-38.7 to 22.9), and 32.3% of patients exhibited a decline of ≥30%. Over a median follow-up of 1.65 years (0.40-2.66), 1420 deaths (43.4%) and 1979 HF-readmissions occurred in 1045 patients. After multivariate analyses, a significant interaction was found between ΔNT-proBNP and LVEF category for all outcomes (P for interaction <.05). Greater NT-proBNP reduction was independently associated with lower risk of all outcomes, but this association weakened at higher LVEF categories and was no longer evident in patients with LVEF ≥65%.

Early NT-proBNP reduction is a robust prognostic marker in AHF with LVEF up to 64%. Its utility is limited in patients with supranormal LVEF.