Prognostic utility of natriuretic peptides in preserved ejection fraction: An exploratory analysis of the biomarkers in acute heart failure (BACH) trial.

Background: Natriuretic peptides (NPs) are well-validated in the diagnosis and prognosis of acute heart failure (HF). In this study, we compared the prognostic utility of NPs in acute systolic versus preserved ejection fraction (EF) HF. Methods: The study was an exploratory analysis of results from the Biomarkers in ACute Heart Failure trial, a multi-center study assessing novel biomarkers in dyspneic patients presenting to the emergency department. Of patients diagnosed with acute HF, discharge plasma levels of NPs including B-type natriuretic peptide, mid-region pro-A-type natriuretic peptide (MRproANP), and amino-terminal pro-BNP were measured. Patients were monitored for 90 days post-discharge for readmission for HF or other cardiac admission and all-cause mortality. Relationships between log-transformed NP levels and outcomes were assessed by Cox regression and receiver-operator curve analysis. Results: Of 1641 patients, 429 had a primary diagnosis of HF and EF data, and of these patients 104 had an event. 162 had an EF 50%. There were 23 events amongst preserved EF patients, and 81 events amongst patients with EF <50%. Amongst all patients with acute HF, the NPs were prognostic. This predictive capacity of NPs was more robust amongst patients with preserved EF (see table). Conclusions: Among decompensated HF patients, discharge NP levels, carry prognostic information. Importantly, this phenomenon is significant and far more pronounced in patients with exacerbation of preserved EF HF.