In patients with heart failure (
HF) and reduced ejection fraction, decreases or increases in NT‐proBNPlevels are associated with better and worse outcomes, respectively. The association in HFand preserved ejection fraction ( HF‐PEF) is unknown. We examined the association between change in level of NT‐proBNPand prognosis in patients with HF‐PEF. Methods and results
We examined the association between change in
NT‐proBNPfrom baseline to 6 months and cardiovascular ( CV) death or HFhospitalization in 2612 participants in the Irbesartan in Patients with Heart Failure and Preserved Systolic Function Study (I‐Preserve). Change in NT‐proBNPwas modelled as a restricted cubic spline in a Cox model after adjusting for baseline NT‐proBNPand known prognostic variables. Median change in NT‐proBNPfrom baseline was −7 pg/ mL(interquartile range −143 to +108). After adjustment, a 1000 pg/ mLdecrease in NT‐proBNPfrom baseline was associated with a reduction in the risk of CVdeath or HFhospitalization [hazard ratio ( HR) 0.73, 95% confidence interval ( CI) 0.53–1.02]; a 1000 pg/ mLincrease was associated with an increase in risk ( HR2.01, 95% CI1.50–2.69). Beyond a 1000 pg/ mLrise or fall, there was little additional change in risk. Addition of change in NT‐proBNPat 6 months to a model with only baseline NT‐proBNPimproved the C‐statistic from 0.752 to 0.769 ( P= 0.013). Conclusion
HF‐PEF, a rise in NT‐proBNPwas associated with an increase in risk of CVdeath or HFhospitalization and a fall was associated with a trend towards a decrease in risk. NT‐proBNPmay be a useful marker to monitor prognosis in this condition.