NT-proBNP levels at discharge are a significant prognostic marker for HFpEF, but personalized cutoffs are necessary based on clinical factors like atrial fibrillation and chronic kidney disease to maintain discriminative performance.
OBJECTIVES: N-terminal pro brain natriuretic peptide (NT-proBNP) is a biomarker for myocardial stress that is used in diagnosing and prognosticating heart failure (HF). However, its interpretation is complicated by clinical factors. This study aims to clarify the prognostic value of NT-proBNP in patients with heart failure with preserved ejection fraction (HFpEF), and risk-prediction cutoffs considering various clinical factors. METHODS: The study used data from the prospective, multicenter, observational Asian HFpEF registry. Patients with acute decompensated HF and left ventricular ejection fraction ≥ 50% were included. NT-proBNP levels were measured at discharge. The primary endpoint was a composite of all-cause death and hospitalization due to HF within 1 year after discharge. RESULTS: A total of 1231 patients (83 77-87 years old, 551 45% male) were enrolled, and 916 eligible patients were analyzed. The median NT-proBNP level was 1060 pg/m. In a multivariable logistic regression model, NT-proBNP was significantly associated with the primary endpoint (adjusted OR for log-transformed NT-proBNP: 2.71, 95% CI: 1.78-4.18; P < 0.001). Subgroup analysis revealed varying NT-proBNP distributions and differential safety cutoffs (329-929 pg/mL) at sensitivity of 0.8 based on factors such as atrial fibrillation and chronic kidney disease, maintaining its discriminatory performance (area under the curve: 0.587-0.734). CONCLUSIONS: NT-proBNP levels at discharge are a significant prognostic marker for HFpEF. Although NT-proBNP levels showed different distributions in various subgroups, and cutoff values were distinctive for each, the prognostic utility was found to be equivalent in almost all subgroups and had similar moderate discriminative performance. The study highlights the necessity of personalized NT-proBNP cutoffs for better management of and prognostication for patients with HFpEF.
Sakamoto et al. (Sat,) studied this question.