Association of NT-proBNP in Patients of Heart Failure with Preserved Ejection Fraction

Syed Murtaza Ali Rizvi; Zahoor Khattak; Nadir Khan; Waheed Ur Rehman; Jawad Gul; Zahid Mumtaz

doi:10.70749/ijbr.v3i4.1076

Authors

Syed Murtaza Ali Rizvi Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Zahoor Khattak Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Nadir Khan Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Waheed Ur Rehman Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Jawad Gul Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Zahid Mumtaz Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i4.1076

Keywords:

Echocardiography, Heart Failure with Preserved Ejection Fraction, N- Terminal B-Type Natriuretic Peptide, Mortality

Abstract

Objective: To determine the association of different levels of N- terminal B-type natriuretic peptide in patients of heart failure with preserved ejection fraction. Study Design: Analytical cross-sectional study. Place and Duration of Study: Department of Cardiology, Armed Forces Institute of Cardiology Rawalpindi from August 06, 2024 to March 05, 2025. Methodology: A total of 368 patients between the age of 20-75 years belonging to both genders with the diagnosis of heart failure with preserved ejection fraction were included in the study. Patients who were obese, had deranged renal profile, atrial fibrillation, and chronic obstructive pulmonary disease were excluded. N- terminal B-type natriuretic peptide levels of all patients were documented and grades of diastolic dysfunction were ascertained. Data analysis was done using SPSS version 25 taking p value of <0.05 as statistically significant. Results: The mean age of patients included in the study was 61.4±11.8 years. There were 157 male patients (42.7%) while 211 patients (57.3%) were female. The mean value of NT-proBNP in patients below 50 years of age was 312.9±271.3 ng/L while the mean value for patients above the age of 50 years was 426.3±571.9 ng/L (p=0.075). The median threshold value in patients with diastolic dysfunction Grade I was 389 pg/L. A statistically significant relationship was found between the values of NT-proBNP and the grades of DD (p<0.001). Conclusion: N- terminal B-type natriuretic peptide is significantly associated with the degree of diastolic dysfunction in patients presenting with heart failure with preserved ejection fraction.

Downloads

Download data is not yet available.

References

Dsouza G, Sharma M. NT-proBNP in heart failure with preserved ejection fraction: a comprehensive review. Indian J Clin Cardiol. 2024;5(4):372-84. https://doi.org/10.1177/26324636241261422.

Vasan RS, Enserro DM, Beiser AS, Xanthakis V. Lifetime risk of heart failure among participants in the Framingham study. J Am Coll Cardiol. 2022;79(3):250-63. https://doi.org/10.1016/j.jacc.2021.10.043.

Bozkurt B, Ahmad T, Alexander KM, Baker WL, Bosak K, Breathett K, et al. Heart failure epidemiology and outcomes statistics: a report of the Heart Failure Society of America. J Card Fail. 2023;29(10):1412-51. https://doi.org/10.1016/j.cardfail.2023.07.006.

Ishaque SS, Ahmed Z, Ahmed S, Meo KA, Rehman AU, Baqai L, et al. A comparison of readmission rates in heart failure with preserved ejection fraction (HFpEF) v/s heart failure with reduced ejection fraction (HFrEF). Pak J Health Sci. 2022;3(07):137-41. https://doi.org/10.54393/pjhs.v3i07.439.

Bayes-Genis A, Cediel G, Domingo M, Codina P, Santiago E, Lupón J. Biomarkers in heart failure with preserved ejection fraction. Card Fail Rev. 2022;8:e20. https://doi.org/10.15420/cfr.2021.37.

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. https://doi.org/10.1093/eurheartj/ehab368.

Paul S, Harshaw-Ellis K. Evolving use of biomarkers in the management of heart failure. Cardiol Rev. 2019;27(3):153-9. https://doi.org/10.1097/CRD.0000000000000224.

Januzzi JL Jr, Myhre PL. The challenges of NT-proBNP testing in HFpEF: shooting arrows in the wind. JACC Heart Fail. 2020;8(5):382-5. https://doi.org/10.1016/j.jchf.2020.03.003.

Çelik A, Kılıçaslan B, Temizhan A, Güvenç TS, Altay H, Çavuşoğlu Y, et al. How to Use natriuretic peptides in patients with heart failure with non-reduced ejection fraction? Anatol J Cardiol. 2023;27(6):308-18. https://doi.org/10.14744/AnatolJCardiol.2023.3297.

Verbrugge FH, Omote K, Reddy YNV, Sorimachi H, Obokata M, Borlaug BA. Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased morbidity and mortality. Eur Heart J. 2022;43(20):1941-51. https://doi.org/10.1093/eurheartj/ehab911.

Birrell H, Isles C, Fersia O, Anwar M, Mondoa C, McFadyen A. Assessment of the diagnostic value of NT-proBNP in heart failure with preserved ejection fraction. Br J Cardiol. 2024;31(1):002. https://doi.org/10.5837/bjc.2024.002.

Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, et al. 2023 ACC Expert Consensus Decision Pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81(18):1835-78. https://doi.org/10.1016/j.jacc.2023.03.393.

Kossaify A, Nasr M. Diastolic dysfunction and the new recommendations for echocardiographic assessment of left ventricular diastolic function: summary of guidelines and novelties in diagnosis and grading. J Diagnos Med Sonogr. 2019;35(4):317-25. https://doi.org/10.1177/8756479319836781.

Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40(40):3297-317. https://doi.org/10.1093/eurheartj/ehz641.

Azzo JD, Dib MJ, Zagkos L, Zhao L, Wang Z, Chang CP, et al. Proteomic associations of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) in heart failure with preserved ejection fraction. Circ Heart Fail. 2024;17(2):e011146. https://doi.org/10.1161/CIRCHEARTFAILURE.123.011146.

Sakamoto D, Sotomi Y, Matsuoka Y, Nakatani D, Okada K, Sunaga A, et al. Prognostic utility and cutoff differences in NT-proBNP levels across subgroups in heart failure with preserved ejection fraction: insights from the PURSUIT-HFpEF Registry. J Card Fail. 2024:S1071-9164(24)00925-4. https://doi.org/10.1016/j.cardfail.2024.10.440.

Welsh P, Campbell RT, Mooney L, Kimenai DM, Hayward C, Campbell A, et al. Reference ranges for NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) and risk factors for higher nt-probnp concentrations in a large general population cohort. Circ Heart Fail. 2022;15(10):e009427. https://doi.org/10.1161/CIRCHEARTFAILURE.121.009427.

Januzzi JL Jr, Chen-Tournoux AA, Christenson RH, Doros G, Hollander JE, Levy PD, et al. N-Terminal Pro-B-Type Natriuretic Peptide in the emergency department: The ICON-RELOADED Study. J Am Coll Cardiol. 2018;71(11):1191-200. https://doi.org/10.1016/j.jacc.2018.01.021.

Lee KK, Doudesis D, Anwar M, Astengo F, Chenevier-Gobeaux C, Claessens YE, et al. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study. BMJ. 2022;377:e068424. https://doi.org/10.1136/bmj-2021-068424.

Toth PP, Gauthier D. Heart failure with preserved ejection fraction: disease burden for patients, caregivers, and the health-care system. Postgrad Med. 2021;133(2):140-5. https://doi.org/10.1080/00325481.2020.1842621.