Correlation of NT-proBNP, C-reactive protein, and renal function with left ventricular ejection fraction in HFpEF and HFmrEF
D Milosevic, S Apostolovic, Z Perisic, B Djindjic, J Perisic, S Dakic, T Filipovic, D StanojevicAbstract
Introduction
Heart failure with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF) are heart failure phenotypes with increasing prevalence, particularly among elderly patients. N-terminal pro–B-type natriuretic peptide (NT-proBNP) is widely used for diagnosis and risk stratification in heart failure. At the same time, C-reactive protein (CRP) has been associated with etiopathogenesis and adverse outcomes in various cardiovascular conditions. Both biomarkers are influenced by renal function. However, the clinical significance of these associations in HFpEF and HFmrEF remains incompletely understood.
Purpose
This study aimed to evaluate the relationships among NT-proBNP, CRP levels, and renal function, as assessed by estimated glomerular filtration rate (eGFR, calculated using the Cockcroft–Gault equation), in patients with HFpEF and HFmrEF.
Methods and Results
We included 60 patients diagnosed with HFpEF (48%) and HFmrEF (52%) within the previous 12 months, all in a stable phase of disease and receiving optimal medical therapy according to ESC guidelines. The mean age was 71.5 ± 6.8 years, and 60% were male. Mean left ventricular ejection fraction (LVEF) was 58.5% ± 8.1 in HFpEF and 45.1% ± 2.7 in HFmrEF patients. The mean CRP level was 6.2 ± 9.5 mg/L, the mean NT-proBNP concentration was 2806 ± 4955 pg/mL, and the mean eGFR was 64.1 ± 23.7 mL/min. There were no statistically significant differences in NT-proBNP concentration, CRP levels, and eGFR between HFpEF and HFmrEF patients. NT-proBNP showed a significant negative correlation with eGFR (ρ = −0.430, p = 0.001), and CRP levels also correlated negatively with eGFR (ρ = −0.257, p = 0.048). A significant positive correlation was observed between NT-proBNP and CRP levels (ρ = 0.420, p = 0.001). Neither NT-proBNP, CRP, nor eGFR showed a significant correlation with LVEF.
Conclusion
In patients with HFpEF and HFmrEF, renal dysfunction and systemic inflammation are significantly correlated with increased myocardial wall stress. However, in our patients, NT-proBNP and CRP were not in correlation with LVEF and did not discriminate between HFpEF and HFmrEF phenotypes. This was also the case with eGFR, given that the mean GFR was above 60ml/min/m2. These findings suggest that NT-proBNP and CRP reflect overlapping pathways of inflammation and myocardial stress, both of which correlate with eGFR. Our findings highlight the potential benefits of using a multimarker approach to better characterize heart failure phenotypes and actively seek new, comprehensive biomarkers of heart failure.