Key result
In patients with HFpEF, having low BNP levels (<100 pg/ml) was not associated with a significant difference in the risk of all-cause mortality or heart failure rehospitalization at 18 months compared to elevated BNP levels (HR 0.63, p=0.179), though these patients had significantly higher BMI.
Why the study?
Does low BNP (<100 pg/ml) compared to elevated BNP (≥100 pg/ml) affect outcomes in patients with HFpEF?
Observational (n=157)
Yes
Does low BNP (<100 pg/ml) compared to elevated BNP (≥100 pg/ml) affect outcomes in patients with HFpEF?
Hazard Ratio: 0.63 (95% CI 0.33–1.23)
p-value: p=0.179
HFpEF patients with low BNP levels (<100 pg/ml) have similar clinical characteristics, symptom severity, and poor outcomes compared to those with elevated BNP, but present with significantly higher BMI.
Low BNP does not identify lower-risk HFpEF patients; leaves open BNP prognostic value amid obesity.
AIMS: Heart failure with preserved ejection fraction (HFpEF) is common and its management remains difficult. B-type natriuretic peptide (BNP) levels are used to diagnose heart failure, and as an entry criterion for inclusion into trials. We investigated a population of HFpEF patients who had been randomised into a study based on clinical parameters, and compared those with low BNP levels to those with elevated BNP levels. METHODS: We examined patients who had been enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure (COACH), with preserved left ventricular ejection fraction (LVEF ≥ 40 %), and compared those with low BNP (< 100 pg/ml; n = 30) to those with elevated BNP (≥ 100 pg/ml; n = 127). Baseline characteristics, comorbidities, biomarkers, quality of life, and outcome parameters (hospitalisations and death) were compared between the groups. To validate our findings, we repeated all analyses for NT-proBNP (< 300 pg/ml and ≥ 300 pg/ml). RESULTS: Patients were similar with regard to most clinical characteristics (including age, sex, and LVEF), biomarkers, and comorbidities. In contrast, patients with a low BNP had higher body mass index levels (31 kg/m(2) vs. 27 kg/m(2); p < 0.01) and lower cardiac troponin I (9 pg/ml vs. 15 pg/ml; p = 0.02). In addition, these patients were less frequently prescribed diuretics and beta-blockers. No differences in quality of life, heart failure related symptoms and the primary and secondary outcomes were observed between these groups. These observations were confirmed for NT-proBNP. CONCLUSION: Among the patients with clinically diagnosed HFpEF, those with low BNP are strikingly similar to those with elevated BNP levels, except for BMI, which was significantly higher in these patients.
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Meijers et al. (2016) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=157). Low BNP (< 100 pg/ml) vs. Elevated BNP (≥ 100 pg/ml) was evaluated on All-cause mortality and/or rehospitalisation for heart failure after 18 months (HR 0.63, 95% CI 0.33-1.23, p=0.179). In patients with HFpEF, having low BNP levels (<100 pg/ml) was not associated with a significant difference in the risk of all-cause mortality or heart failure rehospitalization at 18 months compared to elevated BNP levels (HR 0.63, p=0.179), though these patients had significantly higher BMI.
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