Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction

摘要

Marked elevations of B-type natriuretic peptide(BNP)are not generally seen in patients with heart failure and preserved ejection fraction(HFpEF).The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP.A retrospective examination of 421inpatients at a university hospital admitted with a diagnosis of HFpEF was performed.Clinical and echocardiographic data in 4 groups of patients with levels of BNP≤100 pg/mL,100-400 pg/mL,400-1,000 pg/mL and>1,000 pg/mL were compared.Patients with HFpEF and BNP>1,000 pg/mL(28%of the population)were characterized by impaired renal function and greater use of anti-hypertensive medications.A subset of these patients with BNP>1,000 pg/mL had normal renal function(21%)and were significantly older,more frequently female,and tended to have lower ejection fractions.Conversely,patients with HFpEF and BNP≤100 pg/mL were younger and had preserved renal function.BNP was inversely related to the likelihood of subsequent admission for heart failure,but not to myocardial infarction or death.In conclusion:BNP>1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF.This elevation of BNP often reflects impaired renal function,but can also be seen in patients with preserved renal function but relatively impaired systolic function.