title: How B-Type Natriuretic Peptide (BNP) and Body Weight Changes Vary in Heart Failure With Preserved Ejection Fraction Compared With Reduced Ejection Fraction: Secondary Results of the HABIT (HF Assessment With BNP in the Home) Trial.
abstract: BACKGROUND
  Heart failure is a common cause of hospitalization and can be divided into types with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). In this subanalysis of the HABIT (Heart Failure Assessment With BNP in the Home) trial, we examined the differences between home B-type natriuretic peptide (BNP) testing and weight monitoring in patients with HFpEF and with HFrEF before decompensation.
  
  
  RESULTS
  This was a retrospective review of patients with HFpEF and HFrEF from the HABIT trial. The HFpEF patients compared with HFrEF patients were older and more obese and had lower baseline BNP values. Intra-individual BNP dispersion (spread of distribution over time) was greater in HFpEF than in HFrEF owing to rapid fluctuations (within 3 days). Slowly varying changes in BNP (estimated by a moving average) were equally predictive of ADHF risk in both HFpEF and HFrEF. However, in HFpEF, a rapid rise in BNP >200 pg/mL within 3 days was associated with an increased risk of acute decompensated heart failure (ADHF; hazard ratio 4.0), whereas a similar association was not observed in HFrEF. Weight gain ≥5 lb in 3 days had a high specificity but low sensitivity for ADHF in both HFpEF and HFrEF, whereas a lower threshold of ≥2 lb weight gain over 3 days in patients with HFpEF (but not HFrEF) was a moderately sensitive cutoff associated with decompensation (60% sensitivity).
  
  
  CONCLUSIONS
  Patients with HFpEF and HFrEF have variations in their BNP and weight before decompensation. The rapid time scale behaves differently between the groups. In those with HFpEF, a 3-day period characterized by ≥2 lb weight gain and/or >200 pg/mL BNP rise was significantly associated with decompensation. Future prospective studies investigating different weight and BNP cutoffs for home monitoring of HFpEF and HFrEF patients should be performed to fully learn the value of BNP changes before clinical deompensation.
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, San Diego, California; Division of Cardiology, University of California, San Diego, California. Electronic address: amaisel@ucsd.edu.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
authors.affiliation: Department of Medicine, University of California, San Diego, California.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, San Diego, California.
authors.forename: Denise
authors.initials: D
authors.lastname: Barnard
authors.affiliation: Division of Cardiology, San Diego Cardiac Center, San Diego, California.
authors.forename: Brian
authors.initials: B
authors.lastname: Jaski
authors.affiliation: Division of Cardiology, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California.
authors.forename: Geir
authors.initials: G
authors.lastname: Frivold
authors.affiliation: Division of Cardiology, Care Clinical Research Corporation, Banning, California.
authors.forename: John
authors.initials: J
authors.lastname: Marais
authors.affiliation: Division of Cardiology, St Joseph Hospital, Orange, California.
authors.forename: Maged
authors.initials: M
authors.lastname: Azer
authors.affiliation: Division of Cardiology, Mission Internal Medical Group, St Joseph Heritage Health, Mission Viejo, California.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Miyamoto
authors.affiliation: Division of Cardiology, University of California, San Diego, California.
authors.forename: Dawn
authors.initials: D
authors.lastname: Lombardo
authors.affiliation: Division of Cardiology, Desert Cardiology, Eisenhower Medical Center, Rancho Mirage, California.
authors.forename: Damon
authors.initials: D
authors.lastname: Kelsay
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, San Diego, California.
authors.forename: Navaid
authors.initials: N
authors.lastname: Iqbal
authors.affiliation: Division of Cardiology, University of California, San Diego, California.
authors.forename: Pam R
authors.initials: PR
authors.lastname: Taub
authors.affiliation: Alere Inc., San Diego, California.
authors.forename: Ken
authors.initials: K
authors.lastname: Kupfer
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, San Diego, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Veterans Affairs Medical Center, San Diego, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Zile
authors.affiliation: Division of Cardiology, University of California, San Diego, California.
authors.forename: Barry
authors.initials: B
authors.lastname: Greenberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001835:Body Weight / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009765:Obesity / Q000097:blood / Q000175:diagnosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D015430:Weight Gain / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Home monitoring; heart failure; natriuretic peptide; preserved ejection fraction