NT-proBNP can be used to stratify risk in patients with heart failure regardless of the ejection fraction, a study in Heart has shown.

The Korean Heart Failure registry is a prospective multicentre cohort study of consecutive patients hospitalised for acute heart failure.

Patients with borderline ejection fraction (41-49%) were excluded from the analysis leaving 528 with an ejection fraction  ≥ 50%, categorised as heart failure with preserved ejection fraction (HFpEF), and 1,142 with an ejection fraction ≤ 40% categorised as heart failure with reduced ejection fraction (HFrEF). The median age of patients was 70 and just under half were men.

Patients with HFpEF had a significantly lower median NT-proBNP level than those with HfrEF: 2,723 vs 5,644 ng/L, P < 0.001.

Event rates did not differ between the HFpEF and HFrEF groups either in terms of death from any cause 11.6% vs 13.1%; HR 0.90 (95% CI: 0.67-1.21; P = 0.471) or the composite of death or HF readmission at one year 26.2% vs 29.4%; HR 0.89 (95% CI: 0.73-1.08; P = 0.225).

High levels of NT-proBNP were significantly associated with poor outcomes but interestingly the relationship was the same in both groups. A 10-fold increase in NT-proBNP was associated with a three times higher risk for mortality in both HFpEF and HFrEF.

NT-proBNP is commonly used as a tool to ascertain whether a patient’s symptoms may be caused by cardiac failure and therefore require further investigation with echocardiography. NT-proBNP is also a reliable prognostic factor in patients with heart failure. However, it has not been clear if there is a difference between this prognostic predictive power in HFpEF compared with HFrEF. Although patients with both types of heart failure show similar survival patterns those with a preserved ejection fraction typically have lower natriuretic peptide values than patients with a reduced ejection fraction.

The authors concluded that NT-proBNP is a powerful prognostic factor in both HFpEF and HFrEF. Although patients with HFpEF have lower NT-proBNP levels, the prognosis of a patient with HFpEF expected from a given NT-proBNP level is similar to those with HFrEF.

This study further supports the use of the biomarker NT-proBNP as a tool to stratify risk in patients with heart failure regardless of the ejection fraction.

Dr Peter Savill