Prognostic value of NT-pro-C-type natriuretic peptide (NT-proCNP) in heart failure patients with preserved and reduced ejection fraction

Background: BNP and NT-pro-BNP are established markers in chronic heart failure (HF). C-type Natriuretic Peptide (CNP) belongs to the same peptide family. No data are available of CNP as marker in HF. Objective: To assess the prognostic power of the N-terminal part of pro-CNP (NT-proCNP) in HF. Methods: In 571 patients, NT-proCNP was measured at discharge. Primary endpoint was a composite endpoint of all-cause mortality and HF hospitalization after 18 months. Secondary endpoint was all-cause mortality after 3 years. Results: Mean age was 71±11 years, 62% was male and left ventricular ejection fraction (LVEF) was 32±14%. In a multivariate linear regression model, NT-proCNP showed a positive correlation with NT-proBNP and a negative correlation with renal function and female sex. 240 Patients reached the composite endpoint and 234 died. Interaction analysis revealed a strong interaction between NT-proCNP and LVEF for both endpoints (p-value for interaction: 0.003 respectively 0.008). Therefore further analysis was stratified into patients with a reduced (HFrEF) or preserved (HFpEF) LVEF. In multivariate analyses, each doubling of NT-proCNP was strongly predictive for both the primary (HR 1.72; 95% C1 1.28-2.32; P<0.001) and secondary endpoint (HR 1.72 (1.27-2.34; P=0.001) in patients with HFpEF, but not in patient with HFrEF. View this table: Hazard ratios for doubling of NT-proCNP Conclusion: NT-proCNP is a strong independent marker for outcome in patients with HFpEF.