The Role of NT-proBNP Levels in the Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction-It Is Not Always a Hide-and-Seek Game

Overview

Journal J Cardiovasc Dev Dis

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 26

PMID 39057645

Authors

Christina Chrysohoou

Konstantinos Konstantinou

Kostas Tsioufis

Affiliations

Soon will be listed here.

Abstract

Although heart failure with preserved ejection fraction (HFpEF) has become the predominant heart failure subtype, it remains clinically under-recognized. This has been attributed to the complex pathophysiological mechanisms that accompany individuals with several co-morbidities and symptoms and signs of HFpEF. Natriuretic peptides have been recognized as playing an important role in the diagnosis and monitoring of patients with heart failure with reduced ejection fraction (HFrEF), but their role in HFpEF remains controversial, driven by the different pathophysiological characteristics of these patients. The type of diet consumed has shown various modifying effects on plasma levels of NPs, irrespective of pharmacological treatment.

Citing Articles

The Role of NT-proBNP Levels in the Diagnosis of Hypertensive Heart Disease.

Mouzarou A, Hadjigeorgiou N, Melanarkiti D, Plakomyti T Diagnostics (Basel). 2025; 15(1.

PMID: 39795641 PMC: 11719755. DOI: 10.3390/diagnostics15010113.

Exploring the Relationship Between Ejection Fraction, Arterial Stiffness, NT-proBNP, and Hospitalization Risk in Heart Failure Patients.

Osser G, Osser B, Toth C, Miuta C, Marconi G, Bondar L Diagnostics (Basel). 2025; 14(24.

PMID: 39767246 PMC: 11675150. DOI: 10.3390/diagnostics14242885.

References

Ye B, Bradshaw A, Abrahante J, Dragon J, Haussler T, Bell S . Left Ventricular Gene Expression in Heart Failure With Preserved Ejection Fraction-Profibrotic and Proinflammatory Pathways and Genes. Circ Heart Fail. 2023; 16(8):e010395. PMC: 10430768. DOI: 10.1161/CIRCHEARTFAILURE.123.010395. View

Yang P, Rooney M, Wallace A, Kim H, Echouffo-Tcheugui J, McEvoy J . Associations between diet quality and NT-proBNP in U.S. adults, NHANES 1999-2004. Am J Prev Cardiol. 2023; 16:100528. PMC: 10432600. DOI: 10.1016/j.ajpc.2023.100528. View

Fragopoulou E, Panagiotakos D, Pitsavos C, Chrysohoou C, Nomikos T, Evangelopoulos A . N-terminal ProBNP distribution and correlations with biological characteristics in apparently healthy Greek population: ATTICA study. Angiology. 2009; 61(4):397-404. DOI: 10.1177/0003319709350134. View

Kristensen S, Jhund P, Kober L, McKelvie R, Zile M, Anand I . Relative Importance of History of Heart Failure Hospitalization and N-Terminal Pro-B-Type Natriuretic Peptide Level as Predictors of Outcomes in Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail. 2015; 3(6):478-486. DOI: 10.1016/j.jchf.2015.01.014. View

Billingsley H, Dixon D, Canada J, Kirkman D, Rotelli B, Kadariya D . Time of eating and cardiorespiratory fitness in patients with heart failure with preserved ejection fraction and obesity. Nutr Metab Cardiovasc Dis. 2021; 31(8):2471-2473. PMC: 8277699. DOI: 10.1016/j.numecd.2021.04.018. View

Espino-Gonzalez E, Tickle P, Altara R, Gallagher H, Cheng C, Engman V . Caloric Restriction Rejuvenates Skeletal Muscle Growth in Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci. 2024; 9(2):223-240. PMC: 10950401. DOI: 10.1016/j.jacbts.2023.09.014. View

Pieske B, Tschope C, de Boer R, Fraser A, Anker S, Donal E . How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail. 2020; 22(3):391-412. DOI: 10.1002/ejhf.1741. View

Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y . B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol. 2006; 47(4):742-8. DOI: 10.1016/j.jacc.2005.11.030. View

Obokata M, Reddy Y, Borlaug B . Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: Understanding Mechanisms by Using Noninvasive Methods. JACC Cardiovasc Imaging. 2019; 13(1 Pt 2):245-257. PMC: 6899218. DOI: 10.1016/j.jcmg.2018.12.034. View

10.

Backhaus S, Lange T, George E, Hellenkamp K, Gertz R, Billing M . Exercise Stress Real-Time Cardiac Magnetic Resonance Imaging for Noninvasive Characterization of Heart Failure With Preserved Ejection Fraction: The HFpEF-Stress Trial. Circulation. 2021; 143(15):1484-1498. DOI: 10.1161/CIRCULATIONAHA.120.051542. View

11.

Van Veldhuisen D, Linssen G, Jaarsma T, van Gilst W, Hoes A, Tijssen J . B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013; 61(14):1498-506. DOI: 10.1016/j.jacc.2012.12.044. View

12.

McKie P, Cataliotti A, Lahr B, Martin F, Redfield M, Bailey K . The prognostic value of N-terminal pro-B-type natriuretic peptide for death and cardiovascular events in healthy normal and stage A/B heart failure subjects. J Am Coll Cardiol. 2010; 55(19):2140-7. PMC: 3770189. DOI: 10.1016/j.jacc.2010.01.031. View

13.

Rehman A, Saidullah S, Asad M, Gondal U, Ashraf A, Khan M . Efficacy and safety of semaglutide in patients with heart failure with preserved ejection fraction and obesity. Clin Cardiol. 2024; 47(5):e24283. PMC: 11103635. DOI: 10.1002/clc.24283. View

14.

Lam C, Voors A, de Boer R, Solomon S, Van Veldhuisen D . Heart failure with preserved ejection fraction: from mechanisms to therapies. Eur Heart J. 2018; 39(30):2780-2792. DOI: 10.1093/eurheartj/ehy301. View

15.

Kondo T, Campbell R, Jhund P, Anand I, Carson P, Lam C . Low Natriuretic Peptide Levels and Outcomes in Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail. 2024; 12(8):1442-1455. DOI: 10.1016/j.jchf.2024.04.027. View

16.

Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K . Fluid and Salt Balance and the Role of Nutrition in Heart Failure. Nutrients. 2022; 14(7). PMC: 9002780. DOI: 10.3390/nu14071386. View

17.

van Ham W, Kessler E, Oerlemans M, Handoko M, Sluijter J, van Veen T . Clinical Phenotypes of Heart Failure With Preserved Ejection Fraction to Select Preclinical Animal Models. JACC Basic Transl Sci. 2022; 7(8):844-857. PMC: 9436760. DOI: 10.1016/j.jacbts.2021.12.009. View

18.

Szabo B, Benson L, Savarese G, Hage C, Fudim M, Devore A . Previous heart failure hospitalization, spironolactone, and outcomes in heart failure with preserved ejection fraction - a secondary analysis of TOPCAT. Am Heart J. 2024; 271:136-147. DOI: 10.1016/j.ahj.2024.02.021. View

19.

Ho J, Redfield M, Lewis G, Paulus W, Lam C . Deliberating the Diagnostic Dilemma of Heart Failure With Preserved Ejection Fraction. Circulation. 2020; 142(18):1770-1780. PMC: 7805557. DOI: 10.1161/CIRCULATIONAHA.119.041818. View

20.

Luchner A, Stevens T, Borgeson D, Redfield M, Wei C, Porter J . Differential atrial and ventricular expression of myocardial BNP during evolution of heart failure. Am J Physiol. 1998; 274(5):H1684-9. DOI: 10.1152/ajpheart.1998.274.5.H1684. View