A comparison of the prognostic significance of changes in NT-proBNP
levels in HFrEF and HFpEF.
Abstract
Background: Rising NT-proBNP are associated with reduced survival
patients with HFrEF. However, it remains to be conclusively and formally
demonstrated that the temporal trend in NT-proBNP level carries
prognostic significance in HFpEF. Objective: To determine whether there
is an association between rising NT-proBNP levels and 6-month survival
in patients with HFpEF and HFrEF. Methods: We examined a cohort of 5203
patients to 5 hospitals in a regional health care system — who had at
least one admission to the hospital with diagnoses of heart failure over
a 3-year period. Kaplan-Meier survival curves were constructed for
patients with downtrending (>25% net decrease), stable or
uptrending (>25% net increase) NT-proBNP levels in HF,
HFpEF and HFrEF patients. The log-rank test was used to test for
differences in 6-month survival amongst the groups. Multivariate
extended Cox regression models were constructed for 6-month survival
with NT-proBNP as a time-varying covariate. Age, albumin, sex, race,
serum creatinine, systolic and diastolic blood pressures and Charlson
comorbidity scores at baseline were used as covariates in the model.
Separate analyses were done for HFpEF and HFrEF patients. Results: HFpEF
and HFrEF patients with up-trending levels had significantly lower
6-month survival rates than patients with downtrending or stable
NT-proBNP levels. A doubling of the NT-proBNP level in patients was
significantly associated with reduced 6-month survival in patients with
in both subgroups of HF, HFpEF and HFrEF (HFpEF-HR: 1.53(1.49-2.57),
HFrEF HR: 1.45(1.43-1.48) after adjusting for covariates.