Left ventricular dimension as an independent factor associated with amino-terminal pro-brain natriuretic peptide values in heart failure
M Lorenzo Hernandez, J Montiel, A Gasull, G Nunez, G Minana, R De La Espriella, E Santas, S Villar, P Palau, A Bayes-Genis, J Sanchis, J NunezAbstract
Background
Natriuretic peptides are essential biomarkers for the diagnosis and risk stratification of heart failure (HF). The specific contribution of left ventricular (LV) chamber dimensions to NT-proBNP concentrations remains underexplored.
Objectives
We evaluated the association between LV end-diastolic diameter (LVEDD) and NT-proBNP levels in acute and chronic HF.
Methods
We retrospectively analyzed 8,361 patients (4,374 with acute HF and 3,987 with chronic HF) from four independent cohorts (two derivation and two validation). NT-proBNP levels and echocardiographic measurements were collected during hospitalization or outpatient visits. Quantile regression models tested the independent association between LVEDD and NT-proBNP.
Results
Larger LVEDD was consistently associated with higher NT-proBNP concentrations across the four HF cohorts (p<0.05). This direct linear relationship persisted after multivariable adjustment and across LVEF categories. In the acute HF derivation cohort, a 10 mm increase in LVEDD was associated with an increase in NT-proBNP of 444 pg/mL (95% CI: 266–623, p<0.001). In the chronic HF derivation cohort, the increase was 158 pg/ml (95% CI: 10–305, p=0.036) per 10 mm increase in LVEDD.
Conclusions
LV chamber size is an independent factor associated with NT-proBNP levels in both acute and chronic HF, underscoring the need to consider LV dimensions when interpreting natriuretic peptide levels.Graphic abstractFor image description, please refer to the figure legend and surrounding text.