Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions
Section snippets
Methods
We retrospectively analyzed the combined pooled data of the 2 Japanese prospective AHF registries: the West Tokyo Heart Failure (WET-HF) registry obtained from June 2005 to April 2016, and the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure (NaDEF) registry obtained from January 2013 and August 2015. Details of these registries have been described previously. Briefly, the WET-HF registry is a multicenter, observational, ongoing, prospective cohort registry that
Results
The clinical characteristics of the total population and the HF phenotypes are summarized in Table 1. HFrEF patients had lower age and systolic blood pressure, and lower prevalence of atrial fibrillation and hypertension than patients with other HF phenotypes. Meanwhile, HFrEF patients showed a higher prevalence of men and previous HF, a higher hemoglobin level, and a more frequent use of oral medications for HF. The distributions of admission BNP, discharge BNP, and log-transformed BNP change
Discussion
In the present study, we found that discharge BNP is more reliable than admission BNP and BNP change for predicting long-term adverse outcomes in patients with AHF. Importantly, a significant interaction was observed on the risk of long-term mortality between discharge BNP and new HF phenotypes, with lower HR in HFmrEF and HFpEF patients compared with HFrEF patients.
The optimal timing of BNP measurement (on admission, at discharge, or both) for future outcome prediction after hospitalization
Acknowledgment
The authors are grateful for the contributions of all the investigators, clinical research coordinators, data managers, and laboratory technicians involved in the WET-NaDEF collaboration project.
Disclosures
Toshiyuki Nagai is supported by grants from the Daiichi Sankyo Foundation of Life Science and the Mochida Memorial Foundation for Medical and Pharmaceutical Research. Shun Kohsaka received unrestricted research grant for Department of Cardiology, Keio University School of Medicine from Bayer
References (29)
- et al.
Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure
J Am Coll Cardiol
(2007) - et al.
Validation of the get with the guideline-heart failure risk score in japanese patients and the potential improvement of its discrimination ability by the inclusion of B-type natriuretic peptide level
Am Heart J
(2016) - et al.
Discharge BNP is a stronger predictor of 6-month mortality in acute heart failure compared with baseline BNP and admission-to-discharge percentage BNP reduction
Int J Cardiol
(2016) - et al.
B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction
J Am Coll Cardiol
(2013) - et al.
B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure
J Am Coll Cardiol
(2006) - et al.
The effects of ejection fraction on N-terminal ProBNP and BNP levels in patients with acute CHF: analysis from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study
J Card Fail
(2005) - et al.
Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the breathing not properly multinational study
J Am Coll Cardiol
(2003) - et al.
A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction
Circ Heart Fail
(2011) - et al.
Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction
JACC Heart Fail
(2016) - et al.
Understanding heart failure with mid-range ejection fraction
JACC Heart Fail
(2016)
Heart failure with mid-range (borderline) ejection fraction: clinical implications and future directions
JACC Heart Fail
Mid-range left ventricular ejection fraction: clinical profile and cause of death in ambulatory patients with chronic heart failure
Int J Cardiol
Role of biomarkers for the prevention, assessment, and management of heart failure: a scientific statement from the American Heart Association
Circulation
2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines
Circulation
Cited by (32)
Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction
2024, Hellenic Journal of CardiologyCost-Effectiveness of long-term tolvaptan administration for chronic heart failure treatment in Japan
2022, Journal of CardiologyCitation Excerpt :All transition probabilities were obtained from the literature and expert sources (Table 2). The annual mortality and probability of HF readmission among Japanese patients with CHF with mid-range EF were 10.4% (range, 10.0–11.3%) and 14.7% (range, 14.7–17.7), respectively, based on the pooled data of two Japanese prospective HF registries [36]. The effectiveness of TLV in patients with HF was determined based on the results of our meta-analysis.
Prognostic value of NT-proBNP, and echocardiographic indices of diastolic function, in hospitalized patients with acute heart failure and preserved left ventricular ejection fraction
2020, International Journal of CardiologyCitation Excerpt :Furthermore, echocardiographic variables of systolic and diastolic function were not assessed. Finally, Hamatani et al have recently reported that discharge BNP is a more reliable marker than other BNP parameters in patients with acute heart failure of different EF categories, but it was more accurate in HFrEF than HFpEF patients [8,23]; however, diastolic function was not assessed in that study [22], which may be relevant given that current guidelines attach importance to demonstration of diastolic dysfunction in the diagnosis of HFpEF [13,14]. Prognosis of patients with HFpEF in an acute setting had been addressed in recent clinical trials.
Optimal sampling in derivation studies was associated with improved discrimination in external validation for heart failure prognostic models
2020, Journal of Clinical EpidemiologyCitation Excerpt :CHARMS is a list of key items to extract from individual studies in a systematic review of prediction models. We used cumulative data from the West Tokyo Heart Failure (WET-HF) registry and the National cerebral and cardiovascular center acute DEcompensated heart Failure (NaDEF) registry for applying identified prognostic models [4,26–28]. Both registries adopted the same eligibility criteria and recruited 3,781 consecutive acute HF patients admitted to six referral hospitals in East and West Japan.
Acute Decompensated Heart Failure in Patients with Heart Failure with Preserved Ejection Fraction
2020, Heart Failure ClinicsCitation Excerpt :Higher systolic blood pressure both at peak exercise and at admission for ADHF predicts better prognosis, reflecting LV contractile reserve, whereas higher systolic blood pressure at rest means higher risk in chronic HF. Oppositely, higher B-type natriuretic peptide (BNP) levels predict poor prognosis at rest and during the hospitalized period for ADHF both on admission and before discharge.66 Regarding Paco2, an inverse association was demonstrated between peak exercise Paco2 and severity of HF, leading to poor prognosis.
Patients with HFpEF and HFmrEF have different clinical characteristics in Turkey: A multicenter observational study
2019, European Journal of Internal MedicineCitation Excerpt :This discrepancy may be explained by higher prevalence of the ischemic mitral regurgitaion in patients with HFmrEF; they had more and severe mitral regurgitation but the valvular disease was not the reason of HF in most of the patients. Role of biomarkers in HFmrEF is not well established but recent studies suggest that their prognostic impact may be weakened in HFmrEF compared with HFrEF [23]. Tromp et al. recently analysed a biomarker profile for patients with acute decompensated.
The WET-NaDEF collaboration project was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology (Japan Society for the Promotion of Science [JSPS KAKENHI]), in Tokyo, Japan, Grant 23591062 and 26461088 awarded to TY; a Japan Health Labour Sciences Research in Tokyo, Grant 14528506 awarded to TY; and the Sakakibara Clinical Research Grant for Promotion of Sciences, Japan, 2012, 2013, and 2014 awarded to TY; a grant from the Japan Agency for Medical Research and Development, in Tokyo, Grant 201439013C awarded to SK; a grant from the Japan Cardiovascular Research Foundation, in Bunkyo-Ku, Grant 24-4-2 awarded to TA; and a Grant-in-Aid for Young Scientists from JSPS KAKENHI, Grant 15K19402, awarded to TN.
See page 737 for disclosure information.
- 1
Co-first author.