title: B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction.
abstract: OBJECTIVE
  This study sought to determine the prognostic value of B-type natriuretic peptide (BNP) in patients with heart failure with preserved ejection fraction (HFPEF), in comparison to data in HF patients with reduced left ventricular (LV) EF (≤40%).
  
  
  BACKGROUND
  Management of patients with HFPEF is difficult. BNP is a useful biomarker in patients with reduced LVEF, but data in HFPEF are scarce.
  
  
  METHODS
  In this study, 615 patients with mild to moderate HF (mean age 70 years, LVEF 33%) were followed for 18 months. BNP concentrations were measured at baseline and were related to the primary outcome, that is, a composite of all-cause mortality and HF hospitalization, and to mortality alone. The population was divided in quintiles, according to LVEF, and patients with reduced LVEF were compared with those with HFPEF.
  
  
  RESULTS
  There were 257 patients (42%) who had a primary endpoint and 171 (28%) who died. BNP levels were significantly higher in patients with reduced LVEF than in those with HFPEF (p < 0.001). BNP was a strong predictor of outcome, but LVEF was not. Importantly, if similar levels of BNP were compared across the whole spectrum of LVEF, and for different cutoff levels of LVEF, the associated risk of adverse outcome was similar in HFPEF patients as in those with reduced LVEF.
  
  
  CONCLUSIONS
  BNP levels are lower in patients with HFPEF than in patients with HF with reduced LVEF, but for a given BNP level, the prognosis in patients with HFPEF is as poor as in those with reduced LVEF.
authors.affiliation: Department of Cardiology, University Medical Center, University of Groningen, Groningen, the Netherlands. d.j.van.veldhuisen@umcg.nl
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Gerard C M
authors.initials: GC
authors.lastname: Linssen
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Paulus
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000378:metabolism; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain