Author + information
- Received October 18, 2012
- Revision received December 17, 2012
- Accepted December 17, 2012
- Published online April 9, 2013.
- Dirk J. van Veldhuisen, MD, PhD⁎,⁎ (, )
- Gerard C.M. Linssen, MD, PhD⁎,
- Tiny Jaarsma, RN, PhD†,‡,
- Wiek H. van Gilst, PhD⁎,
- Arno W. Hoes, MD, PhD§,
- Jan G.P. Tijssen, PhD∥,
- Walter J. Paulus, MD, PhD¶,
- Adriaan A. Voors, MD, PhD⁎ and
- Hans L. Hillege, MD, PhD⁎,‡
- ↵⁎Reprint requests and correspondence:
Prof. Dr. Dirk Jan van Veldhuisen, Department of Cardiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB Groningen, the Netherlands
Objectives This study sought to determine the prognostic value of B-type natriuretic peptide (BNP) in patients with heart failure with preserved ejection fraction (HFPEF), in comparison to data in HF patients with reduced left ventricular (LV) EF (≤40%).
Background Management of patients with HFPEF is difficult. BNP is a useful biomarker in patients with reduced LVEF, but data in HFPEF are scarce.
Methods In this study, 615 patients with mild to moderate HF (mean age 70 years, LVEF 33%) were followed for 18 months. BNP concentrations were measured at baseline and were related to the primary outcome, that is, a composite of all-cause mortality and HF hospitalization, and to mortality alone. The population was divided in quintiles, according to LVEF, and patients with reduced LVEF were compared with those with HFPEF.
Results There were 257 patients (42%) who had a primary endpoint and 171 (28%) who died. BNP levels were significantly higher in patients with reduced LVEF than in those with HFPEF (p < 0.001). BNP was a strong predictor of outcome, but LVEF was not. Importantly, if similar levels of BNP were compared across the whole spectrum of LVEF, and for different cutoff levels of LVEF, the associated risk of adverse outcome was similar in HFPEF patients as in those with reduced LVEF.
Conclusions BNP levels are lower in patients with HFPEF than in patients with HF with reduced LVEF, but for a given BNP level, the prognosis in patients with HFPEF is as poor as in those with reduced LVEF.
The main COACH was supported by a large program grant (#2000Z003) from the Netherlands Heart Foundation. An additional unrestricted grant for measurement of B-type natriuretic peptide was obtained (in 2002) from Biosite Europe, France. Dr. van Veldhuisen has received board membership fees and/or travel expenses from Amgen, Johnson & Johnson, Novartis, Sorbent, Vifor, BG Medicine, and BioControl. Dr. Voors has received consultancy fees and/or research grants from Alere, Bayer, Cardio3 Biosciences, Celladon, Ceva, European Commission, Dutch Heart Foundation, Novartis, Servier, Torrent, and Vifor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 18, 2012.
- Revision received December 17, 2012.
- Accepted December 17, 2012.
- American College of Cardiology Foundation