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TOPLINE
In patients with suspected heart failure with preserved ejection fraction (HFpEF), the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular end-diastolic pressure (LVEDP) were discordant in more than 40% of cases. High levels of NT-proBNP were associated with an increased risk for mortality, whereas high levels of LVEDP alone showed no significant association.
METHODOLOGY
- Researchers conducted a prospective cohort study to compare the levels of NT-proBNP and LVEDP simultaneously and assess their association with mortality in patients suspected of having HFpEF.
- They included 514 adults with an ejection fraction of at least 50% who had a score indicating intermediate or high risk for HFpEF at a German hospital between January 2018 and June 2020. The mean age of patients was 70 years, and 49% were women.
- Using guideline-based NT-proBNP thresholds (based on the heart rhythm) and an LVEDP cutoff of ≥ 16 mm Hg, patients were classified into four groups: both normal (29%), only LVEDP high (14%), only NT-proBNP high (28%), and both high (29%).
- The primary endpoint was all-cause death, assessed over a median follow-up duration of 54 months. The analysis models were adjusted for relevant variables.
TAKEAWAY
- Overall, 42% of patients showed discordance between the levels of NT-proBNP and LVEDP, and 58% showed concordance.
- The risk for mortality was 2.26-fold higher in patients with high levels of NT-proBNP (P = .045) and 3.33-fold higher in those with high levels of NT-proBNP and high LVEDP (P = .002) than in those with normal levels of NT-proBNP and normal LVEDP.
- High levels of LVEDP alone were not associated with an increased risk for mortality.
IN PRACTICE
"Integrating biomarker and haemodynamic data may improve phenotyping and risk stratification of patients with suspected HFpEF, but these observational findings require external validation," the researchers wrote.
SOURCE
The study was led by Gülmisal Güder, MD, of the University Hospital Würzburg in Würzburg, Germany. It was published online on September 15 in Heart.
LIMITATIONS
The study was restricted to a single center and to patients referred for elective cardiac catheterization. It did not include systematic screening for cardiac amyloidosis. Hemodynamic measurements were taken at resting state only.
DISCLOSURES
The study received support in the form of institutional funding from Städtisches Krankenhaus Kiel GmbH and the University Hospital Würzburg. Several authors reported receiving fees, consultancy or advisory payments, institutional study fees, research grants, or other industry support, and one reported holding unpaid leadership roles. None of these disclosures were related to this work. Detailed disclosures are available in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
