Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction
In heart failure with preserved ejection fraction (HFpEF), natriuretic peptide (NP) levels are frequently lower. In several trials, the outcome differed between patients with low and high NP levels. This suggests that NP could be used to identify distinct stages of left ventricular (LV) remodeling a...
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MDPI AG
2023-03-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/11/3/867 |
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| author | Elisa Dal Canto Marielle Scheffer Kirsten Kortekaas Annet Driessen-Waaijer Walter J. Paulus Loek van Heerebeek |
| author_facet | Elisa Dal Canto Marielle Scheffer Kirsten Kortekaas Annet Driessen-Waaijer Walter J. Paulus Loek van Heerebeek |
| author_sort | Elisa Dal Canto |
| collection | DOAJ |
| description | In heart failure with preserved ejection fraction (HFpEF), natriuretic peptide (NP) levels are frequently lower. In several trials, the outcome differed between patients with low and high NP levels. This suggests that NP could be used to identify distinct stages of left ventricular (LV) remodeling and myocardial tissue composition. This study investigated cardiac remodeling/dysfunction and myocardial tissue characteristics assessed by echocardiography and cardiac magnetic resonance (CMR) in HFpEF patients in relation to NP levels. Clinical and echocardiographic data of 152 HFpEF patients were derived from outpatient visits. A total of 71 HFpEF patients underwent CMR-derived T1-mapping. Multivariable regression analyses were performed to examine the association of NT-proBNP categories (</> median) and NT-proBNP as continuous variable with echocardiography and CMR-derived T1-mapping. Mean age was 71 ± 9, 93% of patients were women and median NT-proBNP was 195 pg/mL, with 35% of patients below the diagnostic cut-off value (<125 pg/mL). Patients with high NT-proBNP had comparable LV systolic function and LV relaxation but significantly worse LV stiffness and left atrial function compared with patients with low NT-proBNP. Higher NT-proBNP was significantly associated with higher LV stiffness and extracellular volume fraction (ECV) (β = 1.82, 95% CI: 0.19;3.44, <i>p</i> = 0.029). Higher NT-proBNP levels identify HFpEF patients with worse LV stiffness because of more severe myocardial extracellular matrix remodeling, representing an advanced stage of HFpEF. |
| first_indexed | 2024-03-11T06:53:27Z |
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| language | English |
| last_indexed | 2024-03-11T06:53:27Z |
| publishDate | 2023-03-01 |
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| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-4ab2d040c48b4fadbec490fcf472d7492023-11-17T09:46:47ZengMDPI AGBiomedicines2227-90592023-03-0111386710.3390/biomedicines11030867Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection FractionElisa Dal Canto0Marielle Scheffer1Kirsten Kortekaas2Annet Driessen-Waaijer3Walter J. Paulus4Loek van Heerebeek5Laboratory of Experimental Cardiology, Division Heart & Lungs, Utrecht University Medical Centre, 3584 CX Utrecht, The NetherlandsDepartment of Cardiology, OLVG, 1091 AC Amsterdam, The NetherlandsDepartment of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, OLVG, 1091 AC Amsterdam, The NetherlandsAmsterdam University Medical Centers, 1066 CX Amsterdam, The NetherlandsDepartment of Cardiology, OLVG, 1091 AC Amsterdam, The NetherlandsIn heart failure with preserved ejection fraction (HFpEF), natriuretic peptide (NP) levels are frequently lower. In several trials, the outcome differed between patients with low and high NP levels. This suggests that NP could be used to identify distinct stages of left ventricular (LV) remodeling and myocardial tissue composition. This study investigated cardiac remodeling/dysfunction and myocardial tissue characteristics assessed by echocardiography and cardiac magnetic resonance (CMR) in HFpEF patients in relation to NP levels. Clinical and echocardiographic data of 152 HFpEF patients were derived from outpatient visits. A total of 71 HFpEF patients underwent CMR-derived T1-mapping. Multivariable regression analyses were performed to examine the association of NT-proBNP categories (</> median) and NT-proBNP as continuous variable with echocardiography and CMR-derived T1-mapping. Mean age was 71 ± 9, 93% of patients were women and median NT-proBNP was 195 pg/mL, with 35% of patients below the diagnostic cut-off value (<125 pg/mL). Patients with high NT-proBNP had comparable LV systolic function and LV relaxation but significantly worse LV stiffness and left atrial function compared with patients with low NT-proBNP. Higher NT-proBNP was significantly associated with higher LV stiffness and extracellular volume fraction (ECV) (β = 1.82, 95% CI: 0.19;3.44, <i>p</i> = 0.029). Higher NT-proBNP levels identify HFpEF patients with worse LV stiffness because of more severe myocardial extracellular matrix remodeling, representing an advanced stage of HFpEF.https://www.mdpi.com/2227-9059/11/3/867heart failureheart failure with preserved ejection fractionnatriuretic peptidesechocardiographycardiac magnetic resonancefibrosis |
| spellingShingle | Elisa Dal Canto Marielle Scheffer Kirsten Kortekaas Annet Driessen-Waaijer Walter J. Paulus Loek van Heerebeek Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction Biomedicines heart failure heart failure with preserved ejection fraction natriuretic peptides echocardiography cardiac magnetic resonance fibrosis |
| title | Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction |
| title_full | Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction |
| title_fullStr | Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction |
| title_full_unstemmed | Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction |
| title_short | Natriuretic Peptide Levels and Stages of Left Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction |
| title_sort | natriuretic peptide levels and stages of left ventricular dysfunction in heart failure with preserved ejection fraction |
| topic | heart failure heart failure with preserved ejection fraction natriuretic peptides echocardiography cardiac magnetic resonance fibrosis |
| url | https://www.mdpi.com/2227-9059/11/3/867 |
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