Relationship of Ejection Fraction and Natriuretic Peptide Trajectories in Heart Failure with Baseline Reduced and Mid-Range Ejection Fraction.
American Heart Journal
BACKGROUND: The prognostic importance of trajectories of neurohormones relative to left ventricular function over time in heart failure with reduced and mid-range EF (HFrEF and HFmrEF) is poorly defined.
OBJECTIVE: To evaluate left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) trajectories in HFrEF and HFmrEF.
METHODS: Analyses of LVEF and BNP trajectories after incident HF admissions presenting with abnormal LV systolic function were performed using three methods: a Cox proportional hazards model with time-varying covariates, a dual longitudinal-survival model with shared random effects, and an unsupervised analysis to capture three discrete trajectories for each parameter.
RESULTS: Among 1,158 patients (68.9 ± 13.0 years, 53.3% female), both time-varying LVEF measurements (p=0.001) and log-transformed BNP measurements (p=2 × 10-16) were independently associated with survival during 6 years after covariate adjustment. In the dual longitudinal/survival model, both LVEF and BNP trajectories again were independently associated with survival (P
CONCLUSION: Although LVEF trajectories have greater temporal variation, BNP trajectories provide additive prognostication and an even stronger association with survival times in heart failure patients with abnormal LV systolic function.
Bilchick KC, Stafford P, Laja O, Elumogo C, Bediako P, Tolbert N, et al. [Mehta N] Relationship of ejection fraction and natriuretic peptide trajectories in heart failure with baseline reduced and mid-range ejection fraction. Am Heart J. 2022 Jan;243:1-10. doi: 10.1016/j.ahj.2021.08.015. PMID: 34453882.