Utility of NT-proBNP in the Diagnosis of Heart Failure Phenotypes in a Sub-Saharan African Population
Keywords:
N-terminal pro-B-type Natriuretic Peptide, Heart Failure, Diagnosis, Phenotypes, Sub-Saharan Africa, Echocardiography, BiomarkerAbstract
Background: N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) is a cornerstone in the diagnostic algorithm for heart failure (HF). However, its behaviour across different HF phenotypes, particularly in sub-Saharan African (SSA) populations where patient characteristics and HF aetiologies differ, is not well described. This study evaluated the utility of NT-proBNP in diagnosing HF phenotypes in a Nigerian cohort using the 2016 European Society of Cardiology (ESC) criteria.
Methods: In a prospective observational study, 130 adults with HF were classified into HF with reduced ejection fraction (HFrEF, LVEF<40%), mid-range EF (HFmrEF, LVEF 40-49%), and preserved EF (HFpEF, LVEF≥50%) based on comprehensive assessment including echocardiography and clinical evaluation. Plasma NT-proBNP was measured using a high-sensitivity ELISA. The Kruskal-Wallis test was used to compare NT-proBNP levels across phenotypes. Diagnostic performance was assessed by the proportion of patients meeting the ESC NT-proBNP threshold (>125 pg/mL for ambulatory and >300 pg/mL for hospitalized patients).
Results: The median NT-proBNP level for the entire cohort was 3800.0 pg/mL (IQR: 2900.0-4500.0). All 130 patients (100%) had NT-proBNP levels above the ESC diagnostic thresholds. There was no significant difference in median NT-proBNP levels between the three phenotypes (HFrEF: 3900.0 pg/mL [IQR: 3075-4600], HFmrEF: 3700.0 pg/mL [IQR: 2275-3700], HFpEF: 3850.0 pg/mL [IQR: 2700-4325]; p=0.461). The biomarker was equally elevated in both inpatient and outpatient settings.
Conclusion: NT-proBNP is a highly sensitive biomarker for confirming the diagnosis of HF in this SSA population, with 100% of patients exceeding the recommended ESC cut-offs. Contrary to findings from other regions, NT-proBNP levels were uniformly and markedly elevated across all HF phenotypes, showing no discriminatory value between HFrEF, HFmrEF, and HFpEF. This suggests that while NT-proBNP is indispensable for ruling out HF in this setting, its level cannot be used to infer the underlying phenotype.
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