Rasmus Rørth1,2, Pardeep S Jhund1, Mehmet B Yilmaz3, Søren Lund Kristensen1,2, Paul Welsh1, Akshay S Desai4, Lars Køber2, Margaret F Prescott5, Jean L Rouleau6, Scott D Solomon4, Karl Swedberg7, Michael R Zile8, Milton Packer9, John J V McMurray1. 1. BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.R., P.S.J., S.L.K., P.W., J.J.V.M.). 2. Rigshospitalet Copenhagen University Hospital, Copenhagen (R.R., S.L.K., L.K.). 3. Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey (M.B.Y.). 4. Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., S.D.S.). 5. Novartis Pharmaceuticals Corporation, East Hanover, NJ (M.F.P.). 6. Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.). 7. Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden and National Heart and Lung Institute, Imperial College, London (K.S.). 8. Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC (M.R.Z.). 9. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.).
Abstract
BACKGROUND: Both BNP (B-type natriuretic peptide) and NT-proBNP (N-terminal pro B-type natriuretic peptide) are widely used to aid diagnosis, assess the effect of therapy, and predict outcomes in heart failure and reduced ejection fraction. However, little is known about how these 2 peptides compare in heart failure and reduced ejection fraction, especially with contemporary assays. Both peptides were measured at screening in the PARADIGM-HF trial (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). METHODS: Eligibility criteria in PARADIGM-HF included New York Heart Association functional class II to IV, left ventricular ejection fraction ≤40%, and elevated natriuretic peptides: BNP ≥150 pg/mL or NT-proBNP ≥600 pg/mL (for patients with HF hospitalization within 12 months, BNP ≥100 pg/mL or NT-proBNP ≥400 pg/mL). BNP and NT-proBNP were measured simultaneously at screening and only patients who fulfilled entry criteria for both natriuretic peptides were included in the present analysis. The BNP/NT-proBNP criteria were not different for patients in atrial fibrillation. Estimated glomerular filtration rate <30 mL/min per 1.73 m2 was a key exclusion criterion. RESULTS: The median baseline concentration of NT-proBNP was 2067 (Q1, Q3: 1217-4003) and BNP 318 (Q1, Q3: 207-559), and the ratio, calculated from the raw data, was ≈6.25:1. This ratio varied considerably according to rhythm (atrial fibrillation 8.03:1; no atrial fibrillation 5.75:1) and with age, renal function, and body mass index but not with left ventricular ejection fraction. Each peptide was similarly predictive of death (all-cause, cardiovascular, sudden and pump failure) and heart failure hospitalization, for example, cardiovascular death: BNP hazard ratio, 1.41 (95% CI, 1.33-1.49) per 1 SD increase, P<0.0001; NT-proBNP, 1.45 (1.36-1.54); P<0.0001. CONCLUSIONS: The ratio of NT-proBNP to BNP in heart failure and reduced ejection fraction appears to be greater than generally appreciated, differs between patients with and without atrial fibrillation, and increases substantially with increasing age and decreasing renal function. These findings are important for comparison of natriuretic peptide concentrations in heart failure and reduced ejection fraction.
BACKGROUND: Both BNP (B-type natriuretic peptide) and NT-proBNP (N-terminal pro B-type natriuretic peptide) are widely used to aid diagnosis, assess the effect of therapy, and predict outcomes in heart failure and reduced ejection fraction. However, little is known about how these 2 peptides compare in heart failure and reduced ejection fraction, especially with contemporary assays. Both peptides were measured at screening in the PARADIGM-HF trial (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). METHODS: Eligibility criteria in PARADIGM-HF included New York Heart Association functional class II to IV, left ventricular ejection fraction ≤40%, and elevated natriuretic peptides: BNP ≥150 pg/mL or NT-proBNP ≥600 pg/mL (for patients with HF hospitalization within 12 months, BNP ≥100 pg/mL or NT-proBNP ≥400 pg/mL). BNP and NT-proBNP were measured simultaneously at screening and only patients who fulfilled entry criteria for both natriuretic peptides were included in the present analysis. The BNP/NT-proBNP criteria were not different for patients in atrial fibrillation. Estimated glomerular filtration rate <30 mL/min per 1.73 m2 was a key exclusion criterion. RESULTS: The median baseline concentration of NT-proBNP was 2067 (Q1, Q3: 1217-4003) and BNP 318 (Q1, Q3: 207-559), and the ratio, calculated from the raw data, was ≈6.25:1. This ratio varied considerably according to rhythm (atrial fibrillation 8.03:1; no atrial fibrillation 5.75:1) and with age, renal function, and body mass index but not with left ventricular ejection fraction. Each peptide was similarly predictive of death (all-cause, cardiovascular, sudden and pump failure) and heart failure hospitalization, for example, cardiovascular death: BNP hazard ratio, 1.41 (95% CI, 1.33-1.49) per 1 SD increase, P<0.0001; NT-proBNP, 1.45 (1.36-1.54); P<0.0001. CONCLUSIONS: The ratio of NT-proBNP to BNP in heart failure and reduced ejection fraction appears to be greater than generally appreciated, differs between patients with and without atrial fibrillation, and increases substantially with increasing age and decreasing renal function. These findings are important for comparison of natriuretic peptide concentrations in heart failure and reduced ejection fraction.
Authors: Markus Kneihsl; Egbert Bisping; Daniel Scherr; Harald Mangge; Simon Fandler-Höfler; Isabella Colonna; Melanie Haidegger; Sebastian Eppinger; Edith Hofer; Franz Fazekas; Christian Enzinger; Thomas Gattringer Journal: Eur J Neurol Date: 2021-09-23 Impact factor: 6.288
Authors: Pablo Garcia-Pavia; Frank Bengel; Dulce Brito; Thibaud Damy; Franz Duca; Sharmila Dorbala; Jose Nativi-Nicolau; Laura Obici; Claudio Rapezzi; Yoshiki Sekijima; Perry M Elliott Journal: Eur J Heart Fail Date: 2021-05-24 Impact factor: 17.349
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