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Prognostic value of NT-proBNP in heart failure with preserved versus reduced EF
  1. Si-Hyuck Kang1,2,
  2. Jin Joo Park1,
  3. Dong-Ju Choi1,
  4. Chang-Hwan Yoon1,
  5. Il-Young Oh1,
  6. Seok-Min Kang3,
  7. Byung-Su Yoo4,
  8. Eun-Seok Jeon5,
  9. Jae-Joong Kim6,
  10. Myeong-Chan Cho7,
  11. Shung Chull Chae8,
  12. Kyu-Hyung Ryu9,
  13. Byung-Hee Oh2
  14. on behalf of the KorHF Registry
  1. 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  2. 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
  3. 3Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea
  4. 4Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
  5. 5Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Korea
  6. 6Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  7. 7Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
  8. 8Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
  9. 9Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
  1. Correspondence to Dr Dong-Ju Choi, Cardiovascular Center/Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, 13620, Korea; djchoi{at}


Objective Plasma level of N-terminal–pro-brain natriuretic peptide (NT-proBNP) is a reliable prognostic factor in patients with heart failure (HF). However, it is unclear how differently the biomarker predicts adverse outcomes in HF with preserved EF (HFpEF) versus HF with reduced EF (HFrEF).

Methods From the Korean Heart Failure registry, a prospective multicentre cohort for consecutive patients who were hospitalised for acute HF syndrome, those with available NT-proBNP and LVEF measurements were extracted. Patients with LVEF ≥50% were categorised as the HFpEF group (N=528) and those with ≤40% as the HFrEF group (N=1142).

Results Patients with HFpEF had significantly lower NT-proBNP level than those with HFrEF (median 2723 vs 5644 ng/L, p<0.001). Event-free survival did not differ between the two groups either in terms of death from any cause (88.4% vs 86.9%; p=0.471) or the composite of death or HF readmission at 1 year (73.8% vs 70.6%; p=0.225). High levels of NT-proBNP were significantly associated with poor outcomes. However, the relationship was not different among the HFpEF and HFrEF groups (interaction p=0.956 for all-cause death; p=0.351 for the composite of all-cause death or HF hospitalisation).

Conclusions Plasma level of NT-proBNP is the most powerful prognostic factor in both HFpEF and HFrEF. Although patients with HFpEF have lower NT-proBNP levels, the prognosis of a patient with HFpEF expected from a given NT-proBNP level is similar with his/her counterpart with HFrEF.

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