Hamatani Y, et al. - Researchers, herein, focused on the long-term prognostic significance of plasma B-type natriuretic peptide (BNP) level in acute heart failure (AHF) patients with reduced ejection fraction (EF) [(HFrEF)], mid-range EF (HFmrEF), and preserved EF (HFpEF). They found that as far as long-term outcome prediction in these subjects was concerned, discharge BNP was found to be a more reliable marker than other BNP parameters, however, it was observed that its prognostic impact may be weakened in HFmrEF and HFpEF when compared with HFrEF.

Methods

• This study included assessment of a total of 1792 AHF patients consisting of 860 (48%) HFrEF, 318 (18%) HFmrEF, and 614 (34%) HFpEF.
• Using Harrell's c-index, prognostic performance of each BNP parameter was assessed.

Results

• Death of 344 (19%) patients was reported during a median follow-up of 664 days.
• Researchers noted that discharge BNP had the highest c-index (0.69) for mortality amongst all BNP parameters (P <0.001).
• Discharge BNP was associated with mortality in HFrEF, HFmrEF and HFpEF patients with significant interaction, as demonstrated in multivariate Cox proportional hazard modelling (HR 1.95, 95% CI 1.57-2.41; HR 1.76, 95% CI 1.10-2.82; HR 1.46, 95% CI 1.12-1.91, respectively, P=0.011 for interaction).
• Moreover, compared with HFmrEF patients (0.68) and HFpEF patients (0.65), the c-index of discharge BNP for mortality in HFrEF patients (0.72) was higher.
• In addition, similar results were obtained for mortality or HF rehospitalization as alternative outcomes, except there was no statistically significant interaction among HF phenotypes.