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Comparable prognostic impact of BNP levels among HFpEF, Borderline HFpEF and HFrEF: a report from the CHART-2 Study

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Abstract

We aimed to compare the usefulness of plasma levels of B-type natriuretic peptide (BNP) for long-term risk stratification among patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HFpEF), borderline HFpEF, and HF with reduced LVEF (HFrEF) in the same HF cohort. In the CHART-2 Study (N = 10,219), we categorized 4301 consecutive Stage C/D HF patients (mean age 68.7 years, female 32.4%) into 3 groups: HFpEF (LVEF ≥ 50%, N = 2893), borderline HFpEF (LVEF 40–50%, N = 666), and HFrEF (LVEF ≤ 40%, N = 742). During the median 6.3-year follow-up, all-cause deaths occurred in 887 HFpEF, 330 borderline HFpEF, and 330 HFrEF patients. Although median BNP levels increased from HFpEF, borderline HFpEF to HFrEF (85.3, 126 and 208 pg/ml, respectively, P < 0.001), the relationship between log2 BNP levels and the mortality risk was comparable among the 3 groups. As compared with patients with BNP < 30 pg/ml, those with 30–99, 100–299 and ≥ 300 pg/ml had comparably increasing mortality risk among the 3 groups (hazard ratio 2.5, 4.7 and 7.8 in HFpEF, 2.1, 4.2 and 7.0 in borderline HFpEF, and 3.0, 4.7 and 9.5 in HFrEF, respectively, all P < 0.001). BNP levels have comparable prognostic impact among HFpEF, borderline HFpEF, and HFrEF patients.

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Acknowledgements

We thank all the members of the Tohoku Heart Failure Association and the staff of the Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, for their contributions.

The CHART-2 Study investigators: Executive committee: Hiroaki Shimokawa (Chair), Mitsumasa Fukuchi, Toshikazu Goto, Eiji Nozaki, Tetsuya Hiramoto, Satoru Horiguchi, Kanichi Inoue, Atsushi Kato, Hiroshi Kato, Masatoshi Ohe, Tsuyoshi Shinozaki, and Masafumi Sugi. Steering committee: Tetsuya Hiramoto, Kanichi Inoue, Atsushi Kato, Masahiko Ogata, Shoichi Sato, and Masafumi Sugi. Collaborating hospitals and active investigators by prefecture: Aomori prefecture: Shigeto Oyama, and Jun Demachi (Towada City Hospital). Iwate prefecture: Eiji Nozaki, Akihiro Nakamura, Tohru Takahashi, Hideaki Endo, Masateru Kondo, Kazuki Noda, Masanori Kanazawa, and Kenjiro Sato (Iwate Prefectural Central Hospital). Makoto Nakagawa, Tetsuji Nozaki, and Takuya Yagi (Iwate Prefectural Isawa Hospital). Akita prefecture: Toshiaki Takahashi, Satoru Horiguchi, Etsuko Fushimi, Kohei Fukahori, Satoru Takeda, and Sota Nakajima (Hiraka General Hospital). Yamagata prefecture: Masatoshi Ohe, Takurou Tashima, Katsuhiko Sakurai, and Tadashi Kobayashi (Kojirakawa Shiseido Hospital). Toshikazu Goto, Motoyuki Matsui, Yoshiaki Tamada, Tomoyasu Yahagi, Akio Fukui, Katsuaki Takahashi, Shigehiko Kato, and Hyuma Daidouji (Yamagata Prefectural Central Hospital). Miyagi prefecture: Akihiko Sugimura and Junko Ohashi (Sendai Red Cross Hospital). Hiroyuki Kanno and Junji Kaneko (Katta General Hospital). Shu Suzuki and Osamu Kitamukai (KKR Tohoku Kosai Hospital). Dai Katayose (Miyagi Rifu Ekisaikai Hospital). Kaoru Iwabuchi, Sachio Onodera, Seiji Komatsu, Masanobu Chida, Masaharu Takeuchi, Hirokazu Yahagi, and Nozomu Takahashi (Osaki Citizen Hospital). Keiji Otsuka, Yoshito Koseki, and Masaki Morita (Saito Hospital). Tsuyoshi Shinozaki, Takeshi Ishizuka, Noriko Onoue, Nobuhiro Yamaguchi, and Hiroshi Fujita (Sendai Medical Center). Atsushi Kato, Shigeto Namiuchi, Tadashi Sugie, Toru Takii, and Ryoichi Ushigome (Sendai Open Hospital). Yasuharu Matsumoto (Shizugawa Public Hospital). Kanichi Inoue, Jiro Koyama, Tomoko Tomioka, Hiroki Shioiri, and Yoshitaka Ito (South Miyagi Medical Center). Mitsuaki Tanaka, Chikako Takahashi, and Akiko Kawana (Tohoku Rosai Hospital). Tetsuya Hiramoto (Kurihara Central Hospital). Yasuhiko Sakata, Kenta Ito, Masaharu Nakayama, Koji Fukuda, Jun Takahashi, Satoshi Miyata, Koichiro Sugimura, Kimio Sato, Yasuharu Matsumoto, Makoto Nakano, Takashi Shiroto, Kotaro Nochioka, Masanobu Miura, Hiroaki Yamamoto, Tatsuo Aoki, Kiyotaka Hao, Shunsuke Tatebe, Saori Yamamoto, Yoku Kikuchi, Hideaki Suzuki, Shigeo Godo, Kensuke Nishimiya, Nobuhiro Yaoita, and Tomohiko Shindou (Tohoku University Hospital). Fukushima prefecture: Masafumi Sugi, Yoshito Yamamoto, Sunao Toda, Yusuke Takagi, Kentaro Aizawa, Taro Nihei, and Masato Segawa (Iwaki Kyouritsu Hospital). Koji Fukuda (Watanabe Hospital). Head office and coordinating center: Yasuhiko Sakata, Jun Takahashi, Satoshi Miyata, Takashi Shiroto, Kotaro Nochioka, Masanobu Miura, Takeshi Yamauchi, Kanako Tsuji, Takeo Onose, Ruri Abe, Takuya Oikawa, Shintaro Kasahara, Masayuki Sato, Hajime Aoyanagi, Chiharu Saga, Yoko Yamada, Junko Kimura, Hiromi Ogino, Izumi Oikawa, Sanae Watanabe, Yasuko Ikeno, Tomoyuki Suzuki, and Hiroko Hamada.

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Correspondence to Yasuhiko Sakata.

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This study was supported in part by the Grants-in Aid from the Japanese Ministry of Health, Labour, and Welfare and the Japanese Ministry of Education, Culture, Sports, Science, and Technology and the Agency for Medical Research and Development (nos. 15ek0210043h0001, 16ek0210056h0001, 6ek0210043h0002), Tokyo, Japan.

Conflict of interest

The Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine is supported in part by unrestricted research grants from Daiichi Sankyo (Tokyo, Japan), Bayer Yakuhin (Osaka, Japan), Kyowa Hakko Kirin (Tokyo, Japan), Novartis Pharma (Tokyo, Japan), Dainippon Sumitomo Pharma (Osaka, Japan), Astellas Pharma (Tokyo, Japan), AstraZeneca (Osaka, Japan), Chugai Pharmaceutical (Tokyo, Japan), GlaxoSmithKline (Tokyo, Japan), Kowa Pharmaceutical (Tokyo, Japan), Mitsubishi Tanabe Pharma (Osaka, Japan), Mochida Pharmaceutical (Tokyo, Japan), MSD (Tokyo, Japan), Nippon Boehringer Ingelheim (Tokyo, Japan), Otsuka Pharmaceutical (Tokyo, Japan), Shionogi (Osaka, Japan) and Takeda Pharmaceutical (Osaka, Japan). H.S. has received lecture fees from Bayer Yakuhin (Osaka, Japan), Daiichi Sankyo (Tokyo, Japan) and Novartis Pharma (Tokyo, Japan).

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The members of the CHART-2 Investigators are listed in “Acknowledgements” section.

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Kasahara, S., Sakata, Y., Nochioka, K. et al. Comparable prognostic impact of BNP levels among HFpEF, Borderline HFpEF and HFrEF: a report from the CHART-2 Study. Heart Vessels 33, 997–1007 (2018). https://doi.org/10.1007/s00380-018-1150-4

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