Diagnostic and prognostic significance of plasma N-terminal-pro-brain natriuretic peptide in decompensated heart failure with preserved ejection fraction.
BACKGROUND
Preserved ventricular function is increasingly recognised in CHF. Although, NTpro-BNP is a well-established diagnostic marker in heart failure with impaired EF, its significance in heart failure with preserved EF is unclear. NT pro-BNP is secreted from the ventricular wall and plasma levels correlate to ventricular function. This study sought to determine the diagnostic and prognostic significance of plasma NTpro-BNP in patients with preserved EF heart failure.


METHODS
We recruited 133 consecutive patients with decompensated HF. The primary end point was death or hospital readmission.


RESULTS
Median (IQR) NTpro-BNP level at admission was elevated at 5043 ng/L (2693-10,784) and was significantly lower in preserved EF, 3569 ng/L (1707-6340) than in impaired EF, 6363 ng/L (3648-13,250) (P=0.001). Eight (6%) and 19 (14%) patients died after 1 and 6 months, respectively. In a regression analysis, worsening of NTpro-BNP levels after treatment was not predictive of mortality in heart failure with preserved EF (P=0.83). Levels at discharge correlated with readmission rates at 6 months in both groups, i.e. impaired (P=0.03) and preserved EF (P=0.02).


CONCLUSIONS
NTpro-BNP is a reliable diagnostic marker of decompensation. However, in preserved EF heart failure, the plasma levels are significantly lower and a worsening in levels after treatment is not predictive of mortality.
Paul
Biju
B
Department of Cardiac Services, Flinders Medical Centre, Adelaide 5042, Australia. biju.paul@fmc.sa.gov.au
Soon
Kean H
KH
Dunne
James
J
De Pasquale
Carmine G
CG
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010359:Patient Readmission; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain