Key result
Larger LVEDD is linked to ~444 pg/mL higher NT-proBNP per 10 mm in heart failure.
Why the study?
The specific contribution of left ventricular chamber dimensions to NT-proBNP concentrations in heart failure remains underexplored.
Cohort (n=8,361)
Yes
Mean Difference: 444 (95% CI 266–623)
p-value: p=<0.001
Left ventricular chamber size is independently and linearly associated with NT-proBNP levels in both acute and chronic heart failure, indicating that LV dimensions should be considered when interpreting natriuretic peptide concentrations.
LVEDD may confound NT-proBNP interpretation in HF; extends observations but leaves clinical utility open pending validation.
BACKGROUND: The specific contribution of left ventricular chamber dimensions to amino-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations in heart failure remains underexplored. We evaluated the association between left ventricular end-diastolic diameter (LVEDD) and circulating NT-proBNP levels across the spectrum of acute and chronic heart failure. METHODS: We conducted a multicenter retrospective analysis of 8,361 patients (4,374 with acute heart failure and 3,987 with chronic heart failure) from four independent cohorts. NT-proBNP levels and echocardiographic measurements were collected during hospitalization or ambulatory visits. Quantile regression models were used to assess the independent association between LVEDD and NT-proBNP. RESULTS: Larger LVEDD was consistently associated with higher NT-proBNP concentrations across the four heart failure cohorts (p<0.05). This direct linear relationship persisted after multivariable adjustment and across left ventricular ejection fraction categories. A 10 mm increase in LVEDD was associated with an increase in NT-proBNP of 444 pg/mL (95% CI: 266-623, p<0.001) at admission in the acute heart failure derivation cohort of 158 pg/ml (95% CI: 10-305, p=0.036) in the chronic heart failure derivation cohort. In the subset of patients in which CMR was performed, CMR-iLVEDV was also positive and linearly associated with NT-proBNP levels. For each 10 ml/m2 increase, NT-proBNP on admission increased by 290 pg/ml (95% CI: 122-458, p<0.001). Conversely, patients with smaller left ventricular chambers consistently exhibited lower NT-proBNP concentrations. CONCLUSIONS: left ventricular chamber size is an independent factor associated with NT-proBNP levels in both acute and chronic heart failure. These findings underscore the importance of incorporating left ventricular dimensions into the interpretation of natriuretic peptide concentrations.
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Núñez et al. (2026) conducted a cohort in Acute and chronic heart failure (n=8,361). Left ventricular end-diastolic diameter (LVEDD) was evaluated on NT-proBNP concentrations (MD 444 pg/mL per 10 mm increase, 95% CI 266-623, p=<0.001). Larger left ventricular end-diastolic diameter was independently associated with higher NT-proBNP concentrations in both acute (increase of 444 pg/mL per 10 mm; P<0.001) and chronic heart failure.
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