@article {Salah1182, author = {Khibar Salah and Susan Stienen and Yigal M Pinto and Luc W Eurlings and Marco Metra and Antoni Bayes-Genis and Valerio Verdiani and Jan G P Tijssen and Wouter E Kok}, title = {Prognosis and NT-proBNP in heart failure patients with preserved versus reduced ejection fraction}, volume = {105}, number = {15}, pages = {1182--1189}, year = {2019}, doi = {10.1136/heartjnl-2018-314173}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background We assessed the prognostic significance of absolute and percentage change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients hospitalised for acute decompensated heart failure with preservedejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF).Methods Patients with left ventricular ejection fraction >=50\% were categorised as HFpEF (n=283), while those with \<40\% as were categorised as HFrEF (n=776). Prognostic values of absolute and percentage change in NT-proBNP levels for 6 months all-cause mortality after discharge were assessed separately in patients with HFpEF and HFrEF by multivariable adjusted Cox regression analysis. Comorbidities were compared between heart failure groups.Results Discharge NT-proBNP levels predicted outcome similarly in HFpEF and HFrEF: for any 2.7-factor increase in NT-proBNP levels, the HR for mortality was 2.14 for HFpEF (95\% CI 1.48 to 3.09) and 1.96 for HFrEF (95\% CI 1.60 to 2.40). Mortality prediction was equally possible for NT-proBNP reduction of <=30\% (HR 4.60, 95\% CI 1.47 to 14.40 and HR 3.36, 95\% CI 1.93 to 5.85 for HFpEF and HFrEF, respectively) and for \>30\%{\textendash}60\% (HR 3.28, 95\% CI 1.07 to 10.12 and HR 1.79, 95\% CI 0.99 to 3.26, respectively), compared with mortality in the reference groups of \>60\% reductions in NT-proBNP levels. Prognostically relevant comorbidities were more often present in patients with HFpEF than patients with HFrEF in low (<=3000 pg/mL) but not in high (\>3000 pg/mL) NT-proBNP discharge categories.Conclusions Our study highlights{\textemdash}after demonstrating that NT-proBNP levels confer the same relative risk information in HFpEF as in HFrEF{\textemdash}the possibility that comorbidities contribute relatively more to prognosis in patients with HFpEF with lower NT-proBNP levels than in patients with HFrEF.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/105/15/1182}, eprint = {https://heart.bmj.com/content/105/15/1182.full.pdf}, journal = {Heart} }