Baseline plasma NT-proBNP and clinical characteristics: results from the
irbesartan in heart failure with preserved ejection fraction trial.
Author(s): McKelvie RS, Komajda M, McMurray J, Zile M, Ptaszynska A, Donovan M, Carson P,
Massie BM; I-Preserve Investigators.
Affiliation(s): McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
robert.mckelvie@phri.ca
Publication date & source: 2010, J Card Fail. , 16(2):128-34
BACKGROUND: N-terminal B type natriuretic peptide (NT-proBNP) is usually elevated
in heart failure (HF) patients with reduced ejection fraction (EF). Less is known
about NT-proBNP in HF with preserved EF (HF-PEF). We measured baseline NT-proBNP
in 3562 HF-PEF enrolled patients in the Irbesartan in Heart Failure with
Preserved Ejection Fraction trial.
METHODS AND RESULTS: Patients with EF >or=45%, age >or=60 years, and either New
York Heart Association (NYHA) II-IV symptoms with HF hospitalization (HFH) within
6 months or NYHA III-IV symptoms with corroborative evidence of HF or structural
changes associated with HF-PEF. NT-proBNP (pg/mL) measured centrally using the
Elecsys proBNP assay (Roche). Mean age 72 +/- 7 years, 60% were women, the
investigator indicated HF etiology was hypertension in 64%; the majority were in
NYHA III. Medications included diuretics in 82%, angiotensin-converting enzyme
inhibitor in 26%, beta-blocker in 59%, and spironolactone in 15%. Median
NT-proBNP was 341 pg/mL (interquartile range 135 to 974 pg/mL) and geometric mean
was 354 pg/mL. In multivariate analysis, the baseline characteristics most
strongly associated with higher NT-proBNP levels were atrial fibrillation (ratio
of geometric mean 2.59, P < .001), NYHA IV symptoms (1.52, P < .001), lower
estimated glomerular filtration rate (1.44, P < .001), and HFH hospitalization
within 6 months (1.37, P < .001).
CONCLUSIONS: Most HF-PEF patients have elevated NT-proBNP levels. The NT-proBNP
concentrations were related to baseline characteristics generally associated with
worse outcomes for HF patients.
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