NT-proBNP in patients with symptomatic peripheral artery disease

Background

Peripheral Artery Disease (PAD) and Heart Failure (HF) share underlying cause - atherosclerosis and risk factors (diabetes, hypertension, smoking, aging). Patients with symptomatic PAD are less likely to complain of HF symptoms such as fatigue and exertion dyspnoea due to short claudication causing HF to be underdiagnosed in this population.

The aim of the study was to determine the proportion of patients with elevated NT-proBNP among patients with symptomatic PAD.

Methods

In this prospective observational study consecutive symptomatic patients with PAD referred for endovascular treatment were included. Patients with known heart failure were excluded. At admission baseline characteristics were collected and NT-proBNP was measured from a peripheral blood sample.

Results

A total of 99 patients were included in the final analysis, 36 (36.4 %) were women, mean age was 72.5 ± 9.2 years. Arterial hypertension was present in 47 (47.5 %), diabetes mellitus in 44 (44.4 %), atrial fibrillation in 15 (15.2 %) and chronic kidney disease in 21 (21.2 %) participants. Known coronary artery disease was present in 38 (38.4 %) and known cerebrovascular disease in 11 (11.1 %) participants. There were 27 (27.3 %) former smokers and 32 (32.3 %) active smokers. Thirty (30.7 %) participants referred heart failure symptoms (dyspnoea, leg swelling, fatigue). Median NT-proBNP was 212.7 pg/mL (interquartile range 106.2 – 418.9), 86 (72.9 %) participants had a NT-proBNP value above 125 pg/mL. Participants with elevated NT-proBNP were older, had more arterial hypertension, atrial fibrillation and coronary artery disease (table).

Multiple linear regression was used to test whether age, sex, arterial hypertension, atrial fibrillation, and coronary artery disease are correlated with NT-proBNP. The overall regression was statistically significant (R2=0.099, F (5,88)=3.04, p=0.014), coronary artery disease and arterial hypertension were significantly correlated with higher NT-proBNP (β=0.274, p=0.011 and β=0.233, p=0.024).

Conclusion

Our study show that symptomatic PAD patients have elevated values of NT-proBNP, indicating that HF may be underdiagnosed within this patient’s cohort. These results suggest that implementing systematic screening for HF among individuals with PAD could facilitate earlier intervention, thereby potentially enhancing patient outcomes.TableFor image description, please refer to the figure legend and surrounding text.