The association of longitudinal NT-proBNP levels with echocardiographic measurements in heart failure with preserved ejection fraction: Insights from the PURSUIT-HFpEF registry

BACKGROUND: In heart failure with preserved ejection fraction (HFpEF), the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and echocardiographic parameters and the influence of atrial fibrillation (AF) on the relationship remain poorly understood. METHODS: This study analyzed data from the Prospective mUlticenteR obServational stUdy of patIenTs with HFpEF (PURSUIT HFpEF). Patients hospitalized for acute decompensated HF with a left ventricular ejection fraction (LVEF) ≥ 50% were included. The association between longitudinal NT-proBNP levels and echocardiographic parameters was assessed using linear mixed-effects models, with further stratification by AF status. RESULTS: Of 1238 enrolled patients (median age 8377, 87 years; 55145% male), 617 patients with longitudinal NT-proBNP data available (407 without AF, 210 with AF) were analyzed. In patients without AF, even after covariates adjusted, NT-proBNP levels were positively associated with left ventricular diastolic diameter (β-coefficient: 1.878 ± 0.736, P < 0.001), left ventricular mass index (β-coefficient: 1.467 ± 0.280, P < 0.001), left atrial volume index (β-coefficient: 0.795 ± 0.232, P < 0.001), E/e' (β-coefficient: 1.041 ± 0.214, P < 0.001), and tricuspid regurgitation pressure gradient (TRPG) (β-coefficient: 0.849 ± 0.261, P < 0.001). Conversely, left ventricular ejection fraction was negatively associated (β-coefficient: -1.632 ± 0.607, P < 0.001). However, in patients with AF, most of these parameters except for E/e', TRPG, and interventricular septal thickness at end-diastole had no correlation with NT-proBNP levels. CONCLUSIONS: In HFpEF patients without AF, longitudinal NT-proBNP levels were broadly associated with both structural and functional echocardiographic parameters. Whereas, patients with AF showed limited associations. Notably, E/e' and TRPG remained associated with NT-proBNP irrespective of AF status. TRIAL REGISTRATION: UMIN-CTR ID: UMIN000021831.