B-type natriuretic peptide changes and left ventricular remodeling dynamics in heart failure with reduced ejection fraction

TL;DR

This study shows how changes in B-type natriuretic peptide levels are linked to heart structure changes and survival in heart failure patients.

Contribution

The study reveals a time-dependent relationship between BNP changes and left ventricular remodeling in heart failure patients.

Findings

Decreasing BNP levels correlate with improved heart function and reduced chamber size.

Rising BNP levels are associated with higher mortality rates.

BNP changes are dynamically linked to left ventricular remodeling over time.

Abstract

B-type natriuretic peptide (BNP) is an important biomarker in heart failure with reduced ejection fraction (HFrEF). We aimed to explore changes in BNP and their relationship with long-term dynamics of left ventricular (LV) geometry.

This was a single-center retrospective cohort. Inclusion criteria included LV ejection fraction (LVEF) < 40% measured by echocardiography, BNP ≥100 pg/mL at baseline, and a subsequent BNP measure within a year. Percent BNP change from baseline was computed and divided into tertiles. Percent change tertiles represented decreasing (min—max, −63.3 to −10.4), minimal changes (−10.4 to 2.8), and rising BNP levels (2.9 to 12.6). The study endpoint included LV internal dimension at end-systole (LVIDs), LV internal dimension at end-diastole (LVIDd), and LVEF. The secondary endpoint consisted of all-cause mortality.

A total of 887 patients were included. Baseline characteristics, including age, sex, blood pressure, atrial fibrillation, baseline BNP, and LVEF, varied among tertiles (p < 0.05). When comparing to the rising BNP tertile, the decreasing BNP tertile showed decreased trends of LVIDs (p = 0.001), LVIDd (p = 0.006); and increased trends of LVEF (p = 0.008). All-cause mortality was higher in the rising BNP tertile (p < 0.05) compared to the decreasing tertile.

In a real-world routine HFrEF cohort, this study demonstrates the time-dependent relationship between BNP changes, LV remodeling dynamics, and survival outcomes. Findings contribute to the literature supporting BNP as a dynamic marker for LV remodeling.

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