Prevalence and prognosis of heart failure with preserved ejection fraction and elevated N‐terminal pro brain natriuretic peptide: a 10‐year analysis from the Copenhagen Hospital Heart Failure Study

Abstract

AimsThe aim of this study was to assess the epidemiological features and prognosis of heart failure with preserved ejection fraction (HFPEF) and to compare these findings with those from patients with reduced ejection fraction. Furthermore the effects of N-terminal pro brain natriuretic peptide (NT-proBNP) requirement in the heart failure diagnosis were assessed by repeating the analyses in the subgroup of patients with elevated NT-proBNP. Methods and resultsIn 1844 patients admitted, a clinical diagnosis of heart failure was made in 433; amongst these 61% had HFPEF. An elevated NT-proBNP applied to the heart failure diagnosis reduced the number of heart failure patients to 191, and amongst these 29% had preserved ejection fraction. Use of NT-proBNP reduced clinical differences between heart failure patients with preserved and reduced ejection fraction. When not using NT-proBNP, patients with reduced ejection fraction had higher mortality [hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.01-1.52; P ¼ 0.04], even after adjustment for other significant predictors of mortality, except NT-proBNP (HR 1.29, 95% CI 1.04-1.59; P ¼ 0.02). However, no difference in mortality was observed when NT-proBNP was adjusted for (HR 0.90, 95% CI 0.71-1.15; P ¼ 0.4), or used for the heart failure diagnosis (HR 0.96; 95% CI 0.71 -1.29; P ¼ 0.8). ConclusionUsing a heart failure diagnosis requiring elevated NT-proBNP reduces the prevalence of HFPEF and results in a survival similar to that of heart failure with reduced ejection fraction. In contrast, when NT-proBNP is not used for the heart failure diagnosis or adjusted for, HFPEF is associated with a lower mortality in both univariate and multivariate analysis.--

Pathological Ventricular Remodeling

“…Outcomes in RELAX were worse relative to prior HFpEF trials when the more sensitive NT-proBNP assay was required for diagnosis 59 , possibly because this may indicate that the patient's shortness of breath is more likely attributed to heart failure 62 . Other circulating biomarkers have been used to diagnose HFpEF, including procollagen, inflammatory factors (interleukins 6 and 8 and TNFα), matrix metalloproteinase, triiodothyronine, heart-type fatty acid binding proteins, troponin T, and carbohydrate antigen-125 5 .…”

“…Compared with HFrEF, HFpEF patients are classically more likely to be older, hypertensive females 62 . A retrospective study of new-onset HF in Framingham participants between 1981 and 2008 showed that approximately 50% were classified as HFpEF.…”

Preprocedural N‐Terminal Pro‐Brain Natriuretic Peptide (NT‐proBNP) Is Similar to the Mehran Contrast‐Induced Nephropathy (CIN) Score in Predicting CIN Following Elective Coronary Angiography

“…18 Another study conducted in Denmark showed that using a heart failure diagnosis requiring elevated NT‐proBNP reduces the prevalence of heart failure with preserved ejection fraction and results in a survival rate similar to that of heart failure with reduced ejection fraction; the finding supported the use of NT‐proBNP for the selection of high‐risk patients having heart failure with preserved ejection fraction in future interventional clinical trials. 19 In 1 recent study, NT‐proBNP also had strong associations with left ventricular systolic dysfunction, 20 even in patients without clinical heart failure; the study evaluated the cross‐sectional associations of NT‐proBNP with cardiac structural and functional abnormalities in patients with CKD (n=3232). NT‐proBNP significantly reclassified participants' likelihood of having left ventricular systolic dysfunction (net reclassification improvement 0.28, 95% CI: 0.27 to 0.30; P <0.001).…”

Evolving role for mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction

“…This may be related to appropriate identification of patients with HFpEF for clinical trials. Plasma brain natriuretic peptide (BNP) levels are diagnostically helpful because elevated levels not only increase the likelihood that patients have HFpEF but also identify a higher-risk group of patients with HFpEF [13,14]. E/e 0 (the relationship between peak early transmitral ventricular filling velocity and early diastolic tissue Doppler velocity) can help estimate left ventricular filling pressures but can often be abnormal in older patients.…”