Changes in N-terminal pro-B-type natriuretic peptide levels and outcomes in heart failure with preserved ejection fraction: An analysis of the I-Preserve study

Pardeep S. Jhund, Inder Anand, Michel Komajda, Brian L. Claggett, Robert S. McKelvie, Michael R. Zile, Peter E. Carson, John J.V. McMurray

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Aims In patients with heart failure (HF) and reduced ejection fraction, decreases or increases in NT-proBNP levels are associated with better and worse outcomes, respectively. The association in HF and preserved ejection fraction (HF-PEF) is unknown. We examined the association between change in level of NT-proBNP and prognosis in patients with HF-PEF. Methods and results We examined the association between change in NT-proBNP from baseline to 6 months and cardiovascular (CV) death or HF hospitalization in 2612 participants in the Irbesartan in Patients with Heart Failure and Preserved Systolic Function Study (I-Preserve). Change in NT-proBNP was modelled as a restricted cubic spline in a Cox model after adjusting for baseline NT-proBNP and known prognostic variables. Median change in NT-proBNP from baseline was -7 pg/mL (interquartile range -143 to +108). After adjustment, a 1000 pg/mL decrease in NT-proBNP from baseline was associated with a reduction in the risk of CV death or HF hospitalization [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.53-1.02]; a 1000 pg/mL increase was associated with an increase in risk (HR 2.01, 95% CI 1.50-2.69). Beyond a 1000 pg/mL rise or fall, there was little additional change in risk. Addition of change in NT-proBNP at 6 months to a model with only baseline NT-proBNP improved the C-statistic from 0.752 to 0.769 (P = 0.013). Conclusion In HF-PEF, a rise in NT-proBNP was associated with an increase in risk of CV death or HF hospitalization and a fall was associated with a trend towards a decrease in risk. NT-proBNP may be a useful marker to monitor prognosis in this condition.

Original languageEnglish (US)
Pages (from-to)809-817
Number of pages9
JournalEuropean Journal of Heart Failure
Volume17
Issue number8
DOIs
StatePublished - Aug 1 2015

Keywords

  • Biological markers
  • Heart failure
  • Natriuretic peptide
  • Prognosis

Fingerprint

Dive into the research topics of 'Changes in N-terminal pro-B-type natriuretic peptide levels and outcomes in heart failure with preserved ejection fraction: An analysis of the I-Preserve study'. Together they form a unique fingerprint.

Cite this