Impact of Brain Natriuretic Peptide on Long-term Mortality in Acute Heart Failure Patients with Reduced, Mid-range and Preserved Ejection Fraction

Introduction: Brain natriuretic peptide (BNP) is associated with mortality in acute heart failure (AHF) patients. However, it is unclear which BNP parameter; on admission, at discharge, or change during hospitalization, has the highest predictive performance for long-term mortality, and whether its prognostic impact differs according to new European HF phenotype classification by left ventricular ejection fraction (EF); HF with reduced EF (HFrEF), mid-range EF (HFmrEF), and preserved EF (HFpEF). Methods and Results: We examined 3026 consecutive AHF patients from our prospective registries. Prognostic performance of BNP was assessed by Harrell's C-index. During median follow-up of 677 days, 619 patients died. Discharge BNP had the highest C-index, 0.684, for mortality amongst all BNP parameters (P < .001), and was associated with all-cause mortality amongst in HFrEF, HFmrEF, and HFpEF patients with a significant interaction in multivariate Cox proportional hazard model [Hazard ratio (HR) 1.89, 95% confidence interval (CI) 1.53–2.33; HR 1.67, 95% CI 1.12–2.50; HR 1.45, 95% CI 1.13–1.87, respectively, P for interaction = 0.028]. Moreover, C-index of discharge BNP for all-cause mortality in HFrEF patients (0.723) was higher than that in HFmrEF patients (0.674) and HFpEF patients (0.653). Conclusion: In AHF patients, discharge BNP is more reliable marker than other BNP parameters for long-term outcome prediction, but its prognostic impact may be weakened in HFmrEF and HFpEF when compared with HFrEF.