TOPLINE:

Preclinical heart failure (HF) showed a changing course, with many at-risk individuals remaining stable, some developing structural changes or symptoms, and others improving. Higher B-type natriuretic peptide (BNP) levels and abnormal echocardiography predicted worse outcomes.

METHODOLOGY:

• Researchers conducted a retrospective cohort analysis of the STOP-HF study to examine how adults at risk for HF worsened or improved across preclinical stages and which markers predicted these changes.
• They included 1425 adults older than 40 years with risk factors for HF (mean age, 64 years; 54% women) at a single centre in Ireland and followed them for a median duration of 4.5 years.
• Baseline and follow-up assessments included BNP levels, echocardiography, comorbidities, medications, and cardiology review when needed.
• Participants were classified as those with stage A HF (at risk with normal echocardiography) or stage B HF (asymptomatic structural or functional abnormalities).
• Researchers evaluated transitions between stages and hospital events. They assessed whether participants moved to a higher stage or developed symptoms, remained stable, or showed improvement in heart structure and function.

TAKEAWAY:

• At baseline, 67% of participants were in stage A and 33% were in stage B. Over follow-up, 76% of those in stage A remained stable, 22% progressed to stage B, and 1% developed symptomatic HF.
• Among participants in stage B, 72% remained stable, 10% developed symptomatic HF, and 18% improved to stage A.
• Participants who progressed from stage A to stage B had higher median baseline BNP levels than those who remained stable (26.4 vs 12.6 pg/mL; P < .001). Participants in stage B who progressed to symptoms had higher median baseline BNP levels than those who showed improvement (83 vs 22 pg/mL) or those who remained stable (83 vs 51 pg/mL; P < .001 for both). Event rates increased as HF stages advanced.
• Larger left ventricular size and left atrial volume and higher E/e′ ratio (a measure of left ventricular filling pressure) independently predicted HF and cardiovascular events, and BNP independently predicted the risk for overall clinical events.

IN PRACTICE:

"Our data underscore the role of natriuretic peptides in preclinical HF, its transition, and clinical events, enhancing personalized risk assessment. We support reclassifying at-risk individuals with elevated biomarkers to stage B and further exploring regression from stage B," the researchers wrote.

SOURCE:

This study was led by Ashe Moore, University College Dublin, Dublin, Ireland. It was published online on February 11, 2026, in the Journal of the American Heart Association.

LIMITATIONS:

This was a single-centre study of patients referred by family doctors and may not have fully represented the wider HF population. Most participants were White Irish; thus, the results may not have applied to other ethnic groups. Comorbidities and medication use were self‑reported by patients.

DISCLOSURES:

The STOP-HF study received funding from the Heartbeat Trust, the Health Services Executive and the Health Research Board of the Irish Government, and the European Commission Framework Programme 7 Health Project and Metabolic Road to Diastolic Heart Failure project. Some authors reported being named inventors on several patents, receiving honoraria or payments, and having other relationships with industry and research organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.