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 5043ng/L (2693–10,784) and was significantly lower in preserved EF, 3569ng/L (1707–6340) than in impaired EF, 6363ng/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).

Conclusion

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.

Keywords: Heart failure, Natriuretic peptides, Mortality, Readmission