title: Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides.
abstract: OBJECTIVE
  Heart failure with preserved ejection fraction (HFpEF) is common and its management remains difficult. B-type natriuretic peptide (BNP) levels are used to diagnose heart failure, and as an entry criterion for inclusion into trials. We investigated a population of HFpEF patients who had been randomised into a study based on clinical parameters, and compared those with low BNP levels to those with elevated BNP levels.
  
  
  METHODS
  We examined patients who had been enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure (COACH), with preserved left ventricular ejection fraction (LVEF ≥ 40 %), and compared those with low BNP (< 100 pg/ml; n = 30) to those with elevated BNP (≥ 100 pg/ml; n = 127). Baseline characteristics, comorbidities, biomarkers, quality of life, and outcome parameters (hospitalisations and death) were compared between the groups. To validate our findings, we repeated all analyses for NT-proBNP (< 300 pg/ml and ≥ 300 pg/ml).
  
  
  RESULTS
  Patients were similar with regard to most clinical characteristics (including age, sex, and LVEF), biomarkers, and comorbidities. In contrast, patients with a low BNP had higher body mass index levels (31 kg/m(2) vs. 27 kg/m(2); p < 0.01) and lower cardiac troponin I (9 pg/ml vs. 15 pg/ml; p = 0.02). In addition, these patients were less frequently prescribed diuretics and beta-blockers. No differences in quality of life, heart failure related symptoms and the primary and secondary outcomes were observed between these groups. These observations were confirmed for NT-proBNP.
  
  
  CONCLUSIONS
  Among the patients with clinically diagnosed HFpEF, those with low BNP are strikingly similar to those with elevated BNP levels, except for BMI, which was significantly higher in these patients.
authors.affiliation: Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: W C
authors.initials: WC
authors.lastname: Meijers
authors.affiliation: Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Hoekstra
authors.affiliation: Faculty of health sciences, Linköping University, Linköping, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands. r.a.de.boer@umcg.nl.
authors.forename: R A
authors.initials: RA
authors.lastname: de Boer
keywords: B-type Natriuretic peptide; Biomarkers; Heart failure; Preserved ejection fraction; Quality of life; Symptoms