B-type Natriuretic Peptide Changes and Left Ventricular Remodeling Dynamics in Heart Failure with Reduced Ejection Fraction

Background 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. Tertiles represented decreasing, minimal changes, and rising BNP levels. 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. What is new? In a real-world HFrEF cohort, this study demonstrates the time-dependent relationship between BNP changes, LV remodeling dynamics, and survival outcomes. What are the clinical implications?

contribute to the literature supporting early BNP changes as a potential surrogate marker for adverse LV remodeling in a time-dependent fashion. Competing Interest Statement The authors have declared no competing interest. Clinical Trial n/a Funding Statement This work was funded by NIH HeartShare (NIH U01HL160274) and the American Heart Association (AHA) (grant 23SFRNPCS1064232, 23SFRNPCS1060482, and 23SFRNCCS1052478). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was reviewed and approved by UC Davis IRB. All data used were de-identified before analysis. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data will be available upon request. Abbreviations - BNP - B-type natriuretic peptide - GDMT - Guideline-directed medical therapy - HF - Heart failure - HFrEF - Heart failure with reduced ejection fraction - ICD - International Classification of Diseases - LV - Left ventricular - LVAD - Left ventricular assist device - LVEF - Left ventricular ejection fraction - LVIDd - Left ventricular internal dimension at end-diastole - LVIDs - Left ventricular internal dimension at end-systole - MRA - Mineralocorticoid receptor antagonists - NT-proBNP - N-terminal pro-B-type natriuretic peptide - RASi - Renin-angiotensin system inhibitors - SGLT-2 - Sodium-glucose co-transporter 2 inhibitors