Kondo, T. et al. (2024) Low natriuretic peptide levels and outcomes in patients with heart failure and preserved ejection fraction. JACC: Heart Failure, (doi: 10.1016/j.jchf.2024.04.027) (PMID:38904646) (In Press)
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Abstract
Background: Although some patients with heart failure (HF) with mildly reduced/preserved ejection fraction have low natriuretic peptide levels, there are no large-scale systematic studies of how common these individuals are or what happens to them. Objectives: The purpose of this study was to examine the proportion of patients in the I-PRESERVE (Irbesartan in Heart Failure with Preserved Ejection Fraction) trial with an N-terminal pro–B-type natriuretic peptide (NT-proBNP) level <125 pg/mL, their clinical characteristics, and outcomes. Methods: I- PRESERVE enrolled patients with symptomatic HF and a LVEF ≥45% but who did not have NT-proBNP or body mass index inclusion/exclusion criteria. Baseline NT-proBNP was measured after enrollment but not reported to investigators. The primary outcome in this analysis was the composite of cardiovascular death or HF hospitalization. Results: Overall, 808 of 3,480 patients (23.2%) had NT-proBNP <125 pg/mL. Patients with a low NT-proBNP were younger (68.6 years vs 72.6 years; P < 0.001), were less often men (36.1% vs 40.9%; P = 0.015), and had a higher body mass index (48.4% vs 38.7% obese; P < 0.001) than those with a higher NT-proBNP level. Patients with a low NT-proBNP had less atrial fibrillation (8.5% vs 35.1%; P < 0.001), myocardial infarction, diabetes, chronic obstructive pulmonary disease, and anemia but better kidney function. Patients with a lower NT-proBNP level had less marked echocardiographic abnormalities and were less likely to experience cardiovascular death or HF hospitalization; adjusted HR: 0.35 (95% CI: 0.27-0.46; P < 0.001). However, health status was similarly impaired in patients with lower and higher NT-proBNP levels (median Minnesota Living with Heart Failure Questionnaire 43 vs 43; P = 0.95). Conclusions: Almost one-quarter of patients with HF with mildly reduced/preserved ejection fraction had a low NT-proBNP level. Although these patients have a favorable prognosis, compared to those with a high NT-proBNP level, they have similarly impaired health status which should be a target for treatment.
Item Type: | Articles |
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Status: | In Press |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Kondo, Dr Toru and Jhund, Professor Pardeep and Campbell, Dr Ross and McMurray, Professor John |
Authors: | Kondo, T., Campbell, R., Jhund, P. S., Anand, I. S., Carson, P. E., Lam, C. S.P., Shah, S. J., Vaduganathan, M., Zannad, F., Zile, M. R., Solomon, S. D., and McMurray, J. J.V. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | JACC: Heart Failure |
Publisher: | Elsevier |
ISSN: | 2213-1779 |
ISSN (Online): | 2213-1787 |
Published Online: | 19 June 2024 |
Copyright Holders: | Copyright: © 2024 The Authors |
First Published: | First published in JACC: Heart Failure 2024 |
Publisher Policy: | Reproduced under a Creative Commons licence |
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