Brain Natriuretic Peptide (BNP) is an established biomarker used in the management of patients with heart failure (HF). Remote hemodynamic monitoring of pulmonary artery (PA) pressures is an effective means of managing volume status in ambulatory HF patients. The objective of this study was to examine the association between BNP and remotely obtained PA pressures in ambulatory HF patients.
This was a single center, retrospective cohort study of ambulatory patients with NYHA class III HF implanted with the CardioMEMSTM HF sensor. BNP measurements were compared to PA diastolic pressure (PADP) taken within 24-hours of each other. Patients were required to have 3 or more paired BNP-PADP measurements to be included in the analysis. Measurements obtained while patients were receiving sacubitril/valsartan were excluded. Demographics, comorbid conditions, medications and baseline hemodynamics at the time of CardioMEMSTM HF sensor implantation were collected. Data were evaluated with Pearson correlation analysis and fit to a random effects model.
Forty-nine patients were included with a mean age 64±16 years, mean body mass index (BMI) 29.8±8.3 kg/m2, and 38 patients (78%) had HF with reduced ejection fraction (HFrEF). An aggregate of 609 paired BNP-PADP measurements were analyzed. Pearson correlation analysis of the aggregated data showed a significant correlation between BNP and PADP (Pearson's Correlation Coefficient: 0.21, 95% CI: [0.13, 0.28], p<0.0001; Figure). Random effects model analysis showed a significant correlation between BNP and PADP in patients with HFrEF (β=71.80, p<0.001). This relationship was attenuated in patients with HF with preserved ejection fraction (HFpEF) (ß=54.16, p<0.001). BMI did not demonstrate a significant PADP-independent relationship with BNP (p=0.073), but did show a significant PADP-dependent effect on BNP. The PADP-dependent effect was different in patients with BMI ≥ 30 (ß=-1.76, p<0.001) and BMI < 30 (ß=-1.05, p=0.002). Age ≥ 50 years was associated with a PADP-independent decrease in BNP (ß=-794.37, p<0.001).
Brain natriuretic peptide and pulmonary artery diastolic pressure are correlated in patients with ambulatory HF. However, this relationship is complex and related to body mass index, age and ejection fraction.
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