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Total NT-proBNP in heart failure with preserved vs reduced ejection fraction
Camilla Hage1, Anika Mang2, Jean Claude Daubert3
1Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
International Journal of Cardiology
|May 11, 2026
Summary
A new assay measuring total NT-proBNP (tNT-proBNP) shows improved heart failure diagnosis and prognosis compared to standard NT-proBNP. This tNT-proBNP assay may be particularly useful in patients with diabetes.
Area of Science:
- Cardiovascular Medicine
- Biomarker Discovery
- Heart Failure Diagnostics
Background:
- Standard NT-proBNP assays underestimate total NT-proBNP due to antibody binding to glycosylated epitopes.
- This underestimation impairs diagnostic and prognostic accuracy in heart failure (HF) patients.
- Glycosylation patterns differ between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).
Purpose of the Study:
- To evaluate a novel research assay for total NT-proBNP (tNT-proBNP), measuring both glycosylated and unglycosylated forms.
- To compare tNT-proBNP and standard NT-proBNP in patients with HFpEF and HFrEF.
- To assess associations of tNT-proBNP with clinical characteristics and outcomes, and compare prognostic accuracy.
Main Methods:
- Patients with HFpEF (LVEF≥45%) and HFrEF (LVEF<40%) were enrolled.
- Measurements included tNT-proBNP and NT-proBNP.
- Associations with clinical factors, composite outcomes, and prognostic accuracy (AUROC) were analyzed.
Main Results:
- tNT-proBNP and NT-proBNP levels were significantly lower in HFpEF compared to HFrEF patients.
- A strong correlation was observed between tNT-proBNP and NT-proBNP in both HF groups.
- Higher tNT-proBNP was independently associated with adverse outcomes in both HFpEF and HFrEF, with a trend towards superior prognostic ability compared to NT-proBNP.
Conclusions:
- The tNT-proBNP assay demonstrates similar associations with clinical characteristics and outcomes across HFpEF and HFrEF.
- A higher proportion of glycosylated NT-proBNP was observed in HFpEF compared to HFrEF.
- tNT-proBNP shows potential as a superior risk marker, especially in HF populations with glucose metabolism disturbances.
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