Why the study?
Does the discordance between NT-proBNP and LVEDP affect mortality risk in patients with suspected HFpEF?
Cohort (n=514)
Does the discordance between NT-proBNP and LVEDP affect mortality risk in patients with suspected HFpEF?
Hazard Ratio: 3.33 (95% CI 1.54–7.2)
In suspected HFpEF, NT-proBNP and LVEDP are frequently discordant, and elevated NT-proBNP (with or without elevated LVEDP) is associated with increased mortality, whereas isolated LVEDP elevation is not.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Integrating biomarker and haemodynamic data may improve phenotyping and risk stratification of patients with suspected HFpEF, but these observational findings require external validation.”
NT-proBNP elevation may inform mortality risk stratification in suspected HFpEF despite LVEDP discordance; hypothesis-generating and requires prospective validation.
BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, as natriuretic peptides and resting haemodynamic measurements reflect complementary but incomplete aspects of myocardial stress and filling pressure. METHODS: In this prospective all-comer cohort (UKSH-Trial registration number AZ-D412-/21), adults undergoing elective left heart catheterisation underwent simultaneous invasive left ventricular end-diastolic pressure (LVEDP) measurement and N-terminal pro-B-type natriuretic peptide (NT-proBNP) sampling. The H₂FPEF score was calculated in patients with preserved ejection fraction (≥50%), and those with intermediate or high probability were included. Patients were classified using guideline-recommended NT-proBNP thresholds and LVEDP ≥16 mm Hg into four groups: normal (Group 1), isolated LVEDP elevation (Group 2), isolated NT-proBNP elevation (Group 3) and combined elevation (Group 4). The primary endpoint was all-cause mortality, analysed using multivariable Cox models, including age, sex, renal dysfunction and H2FPEF risk category. RESULTS: Among 514 participants (mean age 70 years, 49% women), group distribution was 29%, 14%, 28% and 29%. Discordance was common (42%). Clinical profiles aligned more closely with NT-proBNP than LVEDP. Compared with Group 1, adjusted mortality was not significantly higher in Group 2 (HR 1.34, 95% CI 0.45 to 4.02), whereas it was significantly higher in Group 3 (HR 2.26, 95% CI 1.02 to 5.01) and Group 4 (HR 3.33, 95% CI 1.54 to 7.20). CONCLUSIONS: NT-proBNP and LVEDP are frequently discordant and provide complementary prognostic information in suspected HFpEF. Mortality risk was highest when both were elevated and was also increased with isolated NT-proBNP elevation, whereas isolated LVEDP elevation was not associated with excess mortality. These findings support integrated biomarker-haemodynamic assessment and warrant prospective validation.
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Güder et al. (2026) conducted a cohort in suspected heart failure with a preserved ejection fraction (n=514). Elevated NT-proBNP and/or LVEDP vs. Normal NT-proBNP and LVEDP was evaluated on all-cause mortality (HR 3.33, 95% CI 1.54 to 7.20).
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