Author + information
- Joost D.E. Haeck, MD, PhD∗ ()
- ↵∗Department of Cardiology, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1100DD Amsterdam, the Netherlands
van Veldhuisen et al. (1) reported that B-type natriuretic peptide (BNP) levels are lower in patients with heart failure with preserved ejection fraction (HFPEF) than in patients with HF with reduced left ventricular (LV) EF (≤40%) and that for a certain level of BNP the prognosis in patients with HFPEF is as poor as in those with reduced LVEF.
According to the European Society of Cardiology guidelines the diagnosis of HFPEF requires 4 conditions: symptoms of HF, typical signs of HF, normal or only mildly reduced LVEF with left ventricle with normal dimensions, and relevant structural heart disease (LV hypertrophy/left atrial enlargement) and/or diastolic dysfunction. Importantly, the structural or functional abnormalities are mostly assessed by echocardiography. Echocardiographic measures such as increased left atrial volume index (volume >34 ml/m2), LV filling pressure, or abnormalities of the mitral inflow pattern and tissue velocities are substantial evidence of the presence of HFPEF (2).
In the current study systematic echocardiographic evaluations to examine diastolic dysfunction were not performed. Nevertheless, the authors still report that echocardiography was done in more than 85% of their study population. Unfortunately, no echocardiographic parameters are shown. It would be valuable to also provide information on the echocardiographic values that could give further insight into the determinants of a high or low level of BNP in patients with HFPEF.
- American College of Cardiology Foundation