Background
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.
Methods
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.
Results
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).
Conclusions
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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© 2020 Published by Elsevier Inc.
