# 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.

## Key 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.