Prognosis and NT-proBNP decrease in heart failure patients from admission to follow up

Introduction Natriuretic neurohormone peptides, B-type natriuretic peptide (BNP) and N-terminal prohormone of BNP (NT-proBNP) are established biomarkers for clinical use, enabling the clinician to make a differential diagnosis of dyspnea, and also for risk stratification and prognosis in patients with heart failure (HF). A cutoff value of ≥30% reduction of NT-proBNP after HF hospitalization has been established in several studies, confering these patients a better prognosis than those with a <30% decrease. Purpose We aimed to analyse the factors and characteristics associated with a ≥30% reduction in the levels of NT-proBNP at discharge in a cohort of patients hospitalized for HF in our hospital. Methods This is a prospective, observational and analytical study including all consecutive patients hospitalized for HF at our hospital in whom the levels of NT-proBNP were measured. We compared two groups of patients, considering a cutoff value of 30% decrease in NT-proBNP levels in the first visit after discharge compared to admission, analyzing the factors associated with this significant reduction. The median follow up was 18 [10.5-30.5] months. Results Our sample was composed of 287 patients. There were no significant differences in NT-proBNP reduction associated with sex, cardiovascular risk factors nor chronic kidney disease. Aetiology wasn’t a determinant factor either, with a <30% decrease in NT-proBNP in dilated cardiomyopathy, ischaemic origin or other types of cardiomyopathies. Supraventricular tachyarrhythmias, the need for vasoactive drugs or diuretic resistance weren’t associated with a ≥30% difference in NT-proBNP. There was, however, a significant difference in patients who were discharged on betablockers, sacubitril/valsartan and iSGLT2. As to echocardiographic findings, aortic stenosis was significantly associated with a <30% decrease in NT-proBNP, and patients with significant tricuspid regurgitation tended to have higher NT-proBNP at discharge. As to follow up, we didn’t find any significant differences in prognosis between both groups. However, there was a tendency towards more mortality in the <30% reduction in NT-proBNP group. Conclusions A 30% decrease in NT-proBNP during hospitalization has been a cutoff value that has been well stablished in several studies, associated with a better prognosis in HF. In our cohort some factors associated with this ≥30% reduction were beta blockers, sacubitril/valsartan and iSGLT2, while the presence of aortic stenosis was significantly associated with a <30% decrease. A ≥30% reduction at discharge compared to admission wasn’t associated with better prognosis in our cohort.