Key result
Higher baseline BNP predicts ~229% greater stroke risk in HFpEF, improving clinical risk scores.
Why the study?
BNP is a recognized prognostic biomarker in HFpEF, but its clinical ability to predict stroke risk in this population remains unclear.
Does baseline BNP level predict the risk of stroke in patients with heart failure with preserved ejection fraction?
Cohort (n=799)
Does baseline BNP level predict the risk of stroke in patients with heart failure with preserved ejection fraction?
Baseline BNP is associated with an increased risk of stroke in patients with HFpEF and significantly improves the predictive accuracy of established clinical risk scores like CHA2DS2-VASc.
Answers are grounded in this paper and cite their sources.
May refine stroke risk stratification in HFpEF; leaves open prospective validation and therapeutic implications.
Background B‐type natriuretic peptide (BNP) is a well‐known biomarker for prognosis in heart failure with patients with preserved ejection fraction. However, the clinical predictive ability of BNP for the risk of stroke in HFpEF is not clear. Methods and Results A total of 799 patients with HFpEF from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial were included. Association of baseline BNP with risk of stroke was assessed using the Cox proportional hazard model. The discriminatory ability of BNP was expressed using the C index. The improvement in 5‐year stroke prediction was assessed by C statistic, categorical net reclassification improvement index, and relative integrated discrimination improvement. A total of 34 (4.3%) patients among the 799 patients with HFpEF experienced stroke events over a median of 2.85 years of follow‐up. The stroke group showed a higher BNP level than the nonstroke group (375 pg/mL versus 241 pg/mL, respectively; P =0.006). Higher BNP levels were associated with increased risk of stroke after multivariable adjustment (hazard ratio, 3.29 [95% CI, 1.51–7.16]) and had a moderate performance for stroke prediction (C index, 0.67). Adding BNP to CHADS 2 /CHA 2 DS 2 ‐VASc/R 2 CHADS 2 scores improved their predictive value for stroke (CHADS 2 : C index, 0.67; BNP+CHADS 2 : C index, 0.77; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.0%; CHA 2 DS 2 ‐VASc: C index, 0.64; BNP+CHA 2 DS 2 ‐VASc: C index, 0.74; net reclassification improvement, 41.4%; integrated discrimination improvement, 2.2%; R 2 CHADS 2 : C index, 0.70; BNP+R 2 CHADS 2 : C index, 0.78; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.2%). Conclusions BNP is associated with an increased risk of stroke in patients with HFpEF and may be a valuable biomarker for stroke prediction in HFpEF.
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Liu et al. (2022) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=799). B-type natriuretic peptide (BNP) was evaluated on Risk of stroke (HR 3.29, 95% CI 1.51-7.16). Higher baseline BNP levels were associated with an increased risk of stroke in patients with HFpEF (HR 3.29; 95% CI 1.51-7.16) and improved the predictive value of clinical risk scores.
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