Prognostic value of NT-proBNP, and echocardiographic indices of diastolic function, in hospitalized patients with acute heart failure and preserved left ventricular ejection fraction. (15th October 2020)

• Record Type: Journal Article
• Authors: Blanco, Rocio; Ambrosio, Giuseppe; Belziti, Cesar; Lucas, Luciano; Arias, Anibal; D'Antonio, Antonella; Oberti, Pablo; Carluccio, Erberto; Pizarro, Rodolfo
• Is Part Of: International journal of cardiology. Volume 317(2020)
• Page Start: 111
• Page End: 120
• Publication Date: 2020-10-15
• Subjects: Acute heart failure -- Heart failure with preserved ejection fraction -- Natriuretic peptides -- Diastolic function -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.04.044
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Several parameters have proven useful in assessing prognosis in outpatients with heart failure with preserved ejection fraction (HFpEF). In contrast, prognostic determinants in HFpEF hospitalized for an acute event are poorly investìgated. Aim: To determine the predictive value of NT-proBNP, and diastolic function (assessed by E/e'), in patients with HFpEF hospitalized for acute heart failure. Methods and results: We evaluated 205 consecutive HFpEF patients admitted for acute heart failure (median age: 76[53, 81], 36% male, median EF: 61 [54, 77]). We assessed clinical, echocardiographic, and NT-proBNP values, on admission and at discharge. Primary end-point was the composite of all-cause death and/or HF rehospitalization. After a mean follow up of 28±10 months, 82 patients met the primary end-point; there were 30 deaths (14.6%), and 72 patients (35%) were rehospitalized for HF. By multivariable analysis, predictors of the composite end-point were: discharge E/e´ ≥14 (HR: 4.63 CI 95%: 2.71-18.2, p<0.0001), discharge NT-proBNP ≥1500 pg/ml (HR: 5.23, CI 95%: 2.87–17.8, p < 0.0001), ≥50% NT-proBNP decrease between admission and discharge (HR: 0.62, CI 95%: 0.25-0.79, p = 0.019). Combining E/e´ and NT-proBNP values at discharge further and significantly improved discrimination power compared to each variable analyzed separately (AUC, NT-proBNP at discharge: 0.80; E/e´ at discharge: 0.77; E/e´ + NT-proBNP: 0.88; p < 0.01). Conclusions: In HFpEF patients hospitalized with acute heart failure, assessment of E/e´ ratio and NT-proBNP at discharge provides prognostic information on top of other variables, and allows to easily identify a population at higher risk of subsequent death or rehospitalization for heart failure, during a medium-term follow up. Highlights: Prognostic determinants in HFpEF hospitalized for acute event are poorly investìgatedE. 205 HFpEF patients admitted for acute heart failure enrolled; >2 years follow up. Discharge E/e´ or NT-proBNP predicted events; E/e´ + NT-proBNP refined prediction. Assessment of E/e´ and NT-proBNP at discharge allows identifying HFpEF at higher risk.