Disproportionately low BNP levels in patients of acute heart failure with preserved vs. reduced ejection fraction

Background: B-type natriuretic peptide (BNP) has been widely used for the diagnosis of heart failure, its severity, and prognosis. However, little is known about factors related to disproportionately low BNP levels even during acute heart failure conditions. Methods and results: Among 424 patients hospitalized for acute heart failure, we categorized the patients into the HFpEF (LVEF 50%) or HFrEF (LVEF <_ 50%) group and subdivided them into disproportionately low BNP (LB) group and high BNP (HB) group using a cut-off BNP level of 200 pg/mL at admission. The proportion of patients with LB was higher in the HFpEF group (22.2%) than in the HFrEF group (10.9%, p = 0.002). Patients with LB had a high BMI, lower blood pressure, and history of previous cardiovascular surgery in the HFpEF group, while patients in the HFrEF group had a high BMI and smaller left ventricular end-diastolic volume index. Furthermore, presence of LB in the HFrEF group was related to good prognosis, but LB in the HFpEF group was an indicator of poor prognosis as HB group. Conclusions: The factors associated with LB were different between the HFpEF and HFrEF groups. LB was related to good prognosis in HFrEF, but not in HFpEF. <(c)> 2020 Elsevier B.V. All rights reserved.

Automated summary

This study found that different factors were associated with disproportionately low BNP levels in patients with different types of heart failure. High BMI, lower blood pressure, and history of cardiovascular surgery were related to disproportionately low BNP in the HFpEF group, while high BMI and smaller left ventricular end-diastolic volume index were associated with disproportionately low BNP in the HFrEF group.