Baseline plasma NT-proBNP and clinical characteristics: results from the irbesartan in heart failure with preserved ejection fraction trial.
BACKGROUND
N-terminal B type natriuretic peptide (NT-proBNP) is usually elevated in heart failure (HF) patients with reduced ejection fraction (EF). Less is known about NT-proBNP in HF with preserved EF (HF-PEF). We measured baseline NT-proBNP in 3562 HF-PEF enrolled patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial.


RESULTS
Patients with EF >or=45%, age >or=60 years, and either New York Heart Association (NYHA) II-IV symptoms with HF hospitalization (HFH) within 6 months or NYHA III-IV symptoms with corroborative evidence of HF or structural changes associated with HF-PEF. NT-proBNP (pg/mL) measured centrally using the Elecsys proBNP assay (Roche). Mean age 72 +/- 7 years, 60% were women, the investigator indicated HF etiology was hypertension in 64%; the majority were in NYHA III. Medications included diuretics in 82%, angiotensin-converting enzyme inhibitor in 26%, beta-blocker in 59%, and spironolactone in 15%. Median NT-proBNP was 341 pg/mL (interquartile range 135 to 974 pg/mL) and geometric mean was 354 pg/mL. In multivariate analysis, the baseline characteristics most strongly associated with higher NT-proBNP levels were atrial fibrillation (ratio of geometric mean 2.59, P < .001), NYHA IV symptoms (1.52, P < .001), lower estimated glomerular filtration rate (1.44, P < .001), and HFH hospitalization within 6 months (1.37, P < .001).


CONCLUSIONS
Most HF-PEF patients have elevated NT-proBNP levels. The NT-proBNP concentrations were related to baseline characteristics generally associated with worse outcomes for HF patients.
McKelvie
Robert S
RS
McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. robert.mckelvie@phri.ca
Komajda
Michel
M
McMurray
John
J
Zile
Michael
M
Ptaszynska
Agata
A
Donovan
Mark
M
Carson
Peter
P
Massie
Barry M
BM
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D038622:Internationality; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis / Q000097:blood*; D010446:Peptide Fragments / Q000096:biosynthesis / Q000097:blood*; D011498:Protein Precursors / Q000096:biosynthesis / Q000097:blood*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D013777:Tetrazoles / Q000627:therapeutic use*
D015415:Biomarkers; D001713:Biphenyl Compounds; D010446:Peptide Fragments; D011498:Protein Precursors; D013777:Tetrazoles; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077405:Irbesartan