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Difference in n-terminal pro-b-type natriuretic peptide (NT-proBNP) levels in patients with heart failure with preserved ejection fraction (HFpEF) and non-cardiac comorbidity
1National O.O. Bohomolets Medical University, Department Internal Medicine - Kiev - Ukraine
Multiple studies have already revealed a direct link between non-cardiac comorbidities and the development of HFpEF, emphasizing that it is challenging to assess how significant is a role of the comorbidities and their combinations in elevation of plasma NT-proBNP levels.
Purpose. To estimate the difference between NT-proBNP values in patients with HFpEF, who have one or more concomitant non-cardiac diseases diagnosed prior or during hospitalization, or doesn’t have any of them.
Materials and methods. We enrolled 80 hemodynamically stable patients with HFpEF, confirmed clinically (signs and symptoms), instrumentally (echocardiography with careful evaluation of left ventricle diastolic function) and laboratory (elevated plasma NT-proBNP level). After additional examination (plasma levels of glucose and HbAc1, hemoglobin, ferritin, GFR, calculated by CKD-EPI and spirometry) patients were divided into 4 groups: with 1, 2 or 3 and more concomitant non-cardiac diseases, or without them.
Results. Non-cardiac comorbidity was present in 57 (71,25%) patients. Group 1 included 22 patients (27,5%), Group 2 – 12 (15%), Group 3 – 23 (28,75%) and Group 4 – 13 (16,25%). They didn't differ in age (63,2±10,9 vs 63±6,9 vs 69,9±6,6 and 65±7,7 years), gender (12 (54,5%) vs 7 (58,3%) vs 10 (43,5%) and 8 (61,5%) males) and body mass index (30,9±4,3 vs 28,1±1,9 vs 30,9±4,1 and 28,8±2,7); all p>0,05. Plasma NT-pro-BNP levels are demonstrated in the table. The revealed comorbidities distributed following way: type 1 diabetes mellitus – 23 (28,75%) patients, anemia – 16 (20%) patients, chronic renal impairment – 34 (42,5%), ventilation disorders (obstructive, restrictive and combined) – 29 (36,25%).
Conclusions: Benefits of using comorbidity-oriented approach to assessment of patients with HFpEF can be proven by statistically important difference in mean NT-proBNP levels between groups of patients with concomitant non-cardiac diseases and a group with none of them. Combination of non-cardiac comorbidities, when 3 or more are present, can cause higher levels of NT-proBNP.
*p<0,001 compared to group 3; **p=0,012 compared to group 4; ***p<0,001 compared to group 4.
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