Gianluigi Savarese1, Nicola Orsini2, Camilla Hage3, Ulf Dahlström4, Ola Vedin5, Giuseppe M C Rosano6, Lars H Lund7. 1. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: gianluigi.savarese@ki.se. 2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 3. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 4. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 5. Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center (UCR), Uppsala, Sweden. 6. Cardiovascular and Cell Sciences Research Institute, St George's University, London, UK; Cardiovascular and Cell Sciences Research Institute, St George's University, IRCCS San Raffaele Pisana, Rome, Italy. 7. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
Abstract
BACKGROUND: The aim of this study was to characterize N-terminal pro-B-type natriuretic peptide (NT-proBNP) in terms of determinants of levels and of its prognostic and discriminatory role in heart failure with mid-range (HFmrEF) versus preserved (HFpEF) and reduced (HFrEF) ejection fraction. METHODS AND RESULTS: In 9847 outpatients with HFpEF (n = 1811; 18%), HFmrEF (n = 2122; 22%) and HFrEF (n = 5914; 60%) enrolled in the Swedish Heart Failure Registry, median NT-proBNP levels were 1428, 1540, and 2288 pg/mL, respectively. Many determinants of NT-proBNP differed by ejection fraction, with atrial fibrillation (AF) more important in HFmrEF and HFpEF, diabetes and hypertension in HFmrEF, and age and body mass index in HFrEF and HFmrEF, whereas renal function, New York Heart Association functional class, heart rate, and anemia were similar. Hazard ratios for death and death/HF hospitalization for NT-proBNP above the median ranged from 1.48 to 2.00 and were greatest for HFmrEF and HFpEF. Areas under the receiver operating characteristic curve for death and death/HF hospitalization were greater in HFmrEF than in HFpEF and HFrEF and were reduced by AF in HFpEF and HFmrEF but not in HFrEF. CONCLUSIONS: In HFpEF and especially HFmrEF, NT-proBNP was more prognostic and discriminatory, but also more affected by confounders such as AF. These data support the use of NT-proBNP for eligibility, enrichment, and surrogate end points in HFpEF and HFmrEF trials, and suggest that cutoff levels for eligibility should be carefully tailored to comorbidity.
BACKGROUND: The aim of this study was to characterize N-terminal pro-B-type natriuretic peptide (NT-proBNP) in terms of determinants of levels and of its prognostic and discriminatory role in heart failure with mid-range (HFmrEF) versus preserved (HFpEF) and reduced (HFrEF) ejection fraction. METHODS AND RESULTS: In 9847 outpatients with HFpEF (n = 1811; 18%), HFmrEF (n = 2122; 22%) and HFrEF (n = 5914; 60%) enrolled in the Swedish Heart Failure Registry, median NT-proBNP levels were 1428, 1540, and 2288 pg/mL, respectively. Many determinants of NT-proBNP differed by ejection fraction, with atrial fibrillation (AF) more important in HFmrEF and HFpEF, diabetes and hypertension in HFmrEF, and age and body mass index in HFrEF and HFmrEF, whereas renal function, New York Heart Association functional class, heart rate, and anemia were similar. Hazard ratios for death and death/HF hospitalization for NT-proBNP above the median ranged from 1.48 to 2.00 and were greatest for HFmrEF and HFpEF. Areas under the receiver operating characteristic curve for death and death/HF hospitalization were greater in HFmrEF than in HFpEF and HFrEF and were reduced by AF in HFpEF and HFmrEF but not in HFrEF. CONCLUSIONS: In HFpEF and especially HFmrEF, NT-proBNP was more prognostic and discriminatory, but also more affected by confounders such as AF. These data support the use of NT-proBNP for eligibility, enrichment, and surrogate end points in HFpEF and HFmrEF trials, and suggest that cutoff levels for eligibility should be carefully tailored to comorbidity.
Authors: John Gierula; Richard M Cubbon; Maria F Paton; Rowenna Byrom; Judith E Lowry; Sarah F Winsor; Melanie McGinlay; Emma Sunley; Emma Pickles; Lorraine C Kearney; Aaron Koshy; Thomas A Slater; Hemant K Chumun; Haqeel A Jamil; Kristian M Bailey; Julian H Barth; Mark T Kearney; Klaus K Witte Journal: Eur Heart J Qual Care Clin Outcomes Date: 2019-07-01
Authors: Gianluigi Savarese; Alicia Uijl; Wouter Ouwerkerk; Jasper Tromp; Stefan D Anker; Kenneth Dickstein; Camilla Hage; Carolyn S P Lam; Chim C Lang; Marco Metra; Leong L Ng; Nicola Orsini; Nilesh J Samani; Dirk J van Veldhuisen; John G F Cleland; Adriaan A Voors; Lars H Lund Journal: ESC Heart Fail Date: 2022-04-06
Authors: Björn Eriksson; Per Wändell; Ulf Dahlström; Per Näsman; Lars H Lund; Magnus Edner Journal: Scand J Prim Health Care Date: 2019-11-14 Impact factor: 2.581