Why the study?
Does the brain natriuretic peptide (BNP) level predict cardiovascular death and heart failure hospitalization differently in heart failure patients with relatively low preserved LVEF (40-60%) versus relatively high LVEF (≥60%)?
Cohort (n=288)
open, and blinded endpoint
Yes
Does the brain natriuretic peptide (BNP) level predict cardiovascular death and heart failure hospitalization differently in heart failure patients with relatively low preserved LVEF (40-60%) versus relatively high LVEF (≥60%)?
BNP levels independently predict adverse cardiovascular outcomes in HF patients with LVEF 40-60% (HFrlEF) and LVEF ≤40% (HFrEF), but lose prognostic value in patients with LVEF ≥60% (HFrhEF), indicating that HFrhEF and HFrlEF are pathophysiologically distinct entities.
Answers are grounded in this paper and cite their sources.
BNP should not yet guide risk assessment in HFrhEF; leaves open whether LVEF subgroups warrant distinct prognostic models.
AIMS: Cardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF. METHODS AND RESULTS: The study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J-MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40-60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event-free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178-14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969-44.608, P < 0.001) but not in HFrhEF patients (P = 0.767). CONCLUSIONS: The BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF.
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Kitada et al. (2017) conducted a cohort in Stable heart failure stratified by LVEF: HFrEF (EF <=40%), HFrlEF (EF 40-60%), and HFrhEF (EF >=60%) (n=288). Brain natriuretic peptide (log BNP) levels across LVEF subgroups (HFrlEF vs HFrhEF vs HFrEF) vs. Lower log BNP levels / comparison across LVEF categories (HFrEF <=40%, HFrlEF 40-60%, HFrhEF >=60%) was evaluated on Composite of cardiovascular death and unplanned hospital admission due to acute decompensated heart failure (evaluated for prognostic value of log BNP in HFrlEF) (HR 14.888, 95% CI 4.969-44.608, p=<0.001).
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