Phenotype-Specific Gradients of NT-proBNP Reflect Distinct Functional and Structural Remodeling Signatures in Heart...

Area of Science:

• Cardiology
• Biomarker Research
• Clinical Medicine

Background:

• Current heart failure (HF) classification using left ventricular ejection fraction (LVEF) lacks comprehensive integration of functional, structural, and clinical aspects.
• N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a key biomarker, but its role across diverse HF phenotypes requires further definition.
• Existing research often evaluates NT-proBNP in isolation, limiting understanding of its integrative capacity within the full HF spectrum.

Purpose of the Study:

• To systematically evaluate NT-proBNP concentrations across different HF phenotypes (HFrEF, HFmrEF, HFpEF).
• To assess NT-proBNP's potential as an integrative biomarker linking ventricular dysfunction, structural remodeling, and clinical severity in HF.
• To define the phenotype-specific distribution and integrative capacity of NT-proBNP across the HF spectrum.

Main Methods:

• A cross-sectional study involving 125 participants (65 HF patients, 60 controls).
• HF patients were stratified by LVEF into HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF).
• Serum NT-proBNP levels were measured; clinical (NYHA class) and echocardiographic (LVEF, LVEDD, LAD) parameters were analyzed.

Main Results:

• HF patients exhibited significantly higher NT-proBNP levels than controls (1845 vs. 95.7 pg/mL; p < 0.001).
• A stepwise increase in NT-proBNP was observed across phenotypes: HFrEF (2850.6), HFmrEF (1620.8), and HFpEF (920.9 pg/mL; p < 0.001).
• NT-proBNP strongly correlated inversely with LVEF (r = -0.68) and positively with LVEDD (r = 0.61), LAD (r = 0.57), and NYHA class (p < 0.001).

Conclusions:

• NT-proBNP demonstrates a clear, phenotype-dependent gradient across the HF spectrum.
• The biomarker consistently reflects ventricular dysfunction, adverse structural remodeling, and clinical severity.
• NT-proBNP serves as an integrative biomarker capturing HF's multidimensional nature, supporting phenotype-based risk stratification and clinical decision-making.