Association of cardiac magnetic resonance imaging parameters with N-terminal pro-B-type natriuretic peptide levels

This study aimed to evaluate the associations between serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and conventional and tissue-characterization cardiac magnetic resonance (CMR) imaging parameters.

This retrospective, single-center study included 204 patients who underwent CMR and had NT-proBNP measured within 7 days before or after the examination. Patients were categorized into three groups based on NT-proBNP levels: normal (< 125 pg/mL), high (125-500 pg/mL), and extremely high (> 500 pg/mL). A comparison of CMR-derived structural and functional parameters, including left ventricular ejection fraction, myocardial mass, left atrial (LA) diameter, late gadolinium enhancement (LGE), extracellular volume (ECV), and short tau inversion recovery (STIR)-based T2 signal-intensity (SI) ratio, was performed across groups. Associations were assessed using ordinal and multinomial logistic regression analyses.

Higher NT-proBNP levels were associated with increased myocardial mass, wall thickness, LA enlargement, and reduced systolic function. The LGE burden, LA cavity diameter, and ECV increased significantly across NT-proBNP groups. In adjusted multinomial logistic regression, the ECV and LA cavity diameter were independently associated with both the high and extremely high NT-proBNP groups. The STIR-based T2 SI ratio demonstrated an inverse association with NT-proBNP; however, an independent association was observed only in the extremely high NT-proBNP group (adjusted odds ratio: 0.80, P = 0.034), and this finding should be considered exploratory.

Higher NT-proBNP categories were associated with greater structural abnormalities and tissue-characterization changes on CMR, particularly a higher ECV and larger LA diameter. The inverse association observed with the STIR-based T2 SI ratio was limited to the extremely high NT-proBNP group and should be considered exploratory.

Elevated NT-proBNP levels were associated with CMR findings consistent with myocardial remodeling, particularly increased ECV expansion.