B-Type Natriuretic Peptide and Prognosis in Heart Failure Patients With Preserved and Reduced Ejection Fraction

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• 作者：Dirk J. van Veldhuisen ; MD ; PhD^? ; ^{d.j.van.veldhuisen@umcg.nl} ; Gerard C.M. Linssen ; MD ; PhD^? ; Tiny Jaarsma ; RN ; PhD^&dagger ; ; ^&Dagger ; ; Wiek H. van Gilst ; PhD^? ; Arno W. Hoes ; MD ; PhD^&sect ; ; Jan G.P. Tijssen ; PhD^¡Î ; Walter J. Paulus ; MD ; PhD^¶ ; ; Adriaan A. Voors ; MD ; PhD^? ; Hans L. Hillege ; MD ; PhD^? ; ^&Dagger ;
• 关键词：heart failure ; natriuretic peptides ; preserved ejection fraction ; prognosis
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：9 April, 2013
• 年：2013
• 卷：61
• 期：14
• 页码：1498-1506
• 全文大小：1320 K

文摘

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class=""h4"">Objectives

This study sought to determine the prognostic value of B-type natriuretic peptide (BNP) in patients with heart failure with preserved ejection fraction (HFPEF), in comparison to data in HF patients with reduced left ventricular (LV) EF (¡Ü40 % ).

class=""h4"">Background

Management of patients with HFPEF is difficult. BNP is a useful biomarker in patients with reduced LVEF, but data in HFPEF are scarce.

class=""h4"">Methods

In this study, 615 patients with mild to moderate HF (mean age 70 years, LVEF 33 % ) were followed for 18 months. BNP concentrations were measured at baseline and were related to the primary outcome, that is, a composite of all-cause mortality and HF hospitalization, and to mortality alone. The population was divided in quintiles, according to LVEF, and patients with reduced LVEF were compared with those with HFPEF.

class=""h4"">Results

There were 257 patients (42 % ) who had a primary endpoint and 171 (28 % ) who died. BNP levels were significantly higher in patients with reduced LVEF than in those with HFPEF (p < 0.001). BNP was a strong predictor of outcome, but LVEF was not. Importantly, if similar levels of BNP were compared across the whole spectrum of LVEF, and for different cutoff levels of LVEF, the associated risk of adverse outcome was similar in HFPEF patients as in those with reduced LVEF.

class=""h4"">Conclusions

BNP levels are lower in patients with HFPEF than in patients with HF with reduced LVEF, but for a given BNP level, the prognosis in patients with HFPEF is as poor as in those with reduced LVEF.