Comparable Prognostic Impacts of Plasma BNP Levels Among HFpEF, Borderline HFpEF, and HFpEF-A Report From the CHART-2 Study

Background: Although the usefulness of plasma levels of B-type natriuretic peptide (BNP) as a prognostic indicator has been established for patients with heart failure (HF) with reduced ejection fraction (EF) (HFrEF, EF ≤ 40%), it remains unknown whether BNP is also a useful prognostic marker for HF with preserved EF (HFpEF, EF > 50%) or borderline HFpEF (40% < EF ≤ 50%). Methods and Results: We analyzed the data of 4301 consecutive chronic HF patients in stage C/D (mean 69 years, female 32%) in our CHART-2 Study (N = 10,219). During median 6.3-year follow up, 887, 218 and 330 all-cause deaths occurred in HFpEF (N = 2893), borderline HFpEF (N = 666) and HFrEF (N = 742), respectively. Although median BNP levels progressively increased from HFpEF, borderline HFpEF to HFrEF (85.3, 127 and 216 pg/mL, respectively P < .001), the relationship between log₂ BNP levels and the mortality risk was comparable among the 3 groups. Moreover, log₂ BNP levels were similarly associated with cardiovascular and non-cardiovascular deaths and HF admission in all groups. In addition, when evaluated with the cutoff BNP levels obtained by the survival CART (classification and regression trees) analysis, the mortality risk was effectively stratified by the BNP levels in each group; patients with 30–100, 100–300 and ≥300 pg/mL had comparably increasing mortality risk in all classes. Conclusion: BNP levels had comparable prognostic impacts among HFpEF, borderline HFpEF and HFrEF.