The American journal of medicine · 2026
Left ventricular dimension as an independent factor associated with amino-terminal pro-brain natriuretic peptide values in heart failure.
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Núñez Julio, Lupón Josep, Jenkins Freya Sophie, Miñana Gema, Santas Enrique, Lorenzo Miguel, de la Espriella Rafael, Bodí Vicent, Sanchis Juan, Anker Markus S, Docherty Kieran F, Ibáñez Borja, Mueller Christian, Bayés-Genís Antoni
Аннотация
BACKGROUND: The specific contribution of left ventricular chamber dimensions to amino-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations in heart failure remains underexplored. We evaluated the association between left ventricular end-diastolic diameter (LVEDD) and circulating NT-proBNP levels across the spectrum of acute and chronic heart failure.
METHODS: We conducted a multicenter retrospective analysis of 8,361 patients (4,374 with acute heart failure and 3,987 with chronic heart failure) from four independent cohorts. NT-proBNP levels and echocardiographic measurements were collected during hospitalization or ambulatory visits. Quantile regression models were used to assess the independent association between LVEDD and NT-proBNP.
RESULTS: Larger LVEDD was consistently associated with higher NT-proBNP concentrations across the four heart failure cohorts (P < 0.05). This direct linear relationship persisted after multivariable adjustment and across left ventricular ejection fraction categories. A 10 mm increase in LVEDD was associated with an increase in NT-proBNP of 444 pg/mL (95% CI: 266-623, P < 0.001) at admission in the acute heart failure derivation cohort of 158 pg/ml (95% CI: 10-305, P = 0.036) in the chronic heart failure derivation cohort. In the subset of patients in which CMR was performed, CMR-iLVEDV was also positive and linearly associated with NT-proBNP levels. For each 10 ml/m2 increase, NT-proBNP on admission increased by 290 pg/ml (95% CI: 122-458, P < 0.001). Conversely, patients with smaller left ventricular chambers consistently exhibited lower NT-proBNP concentrations.
CONCLUSIONS: Left ventricular chamber size is an independent factor associated with NT-proBNP levels in both acute and chronic heart failure. These findings underscore the importance of incorporating left ventricular dimensions into the interpretation of natriuretic peptide concentrations.
METHODS: We conducted a multicenter retrospective analysis of 8,361 patients (4,374 with acute heart failure and 3,987 with chronic heart failure) from four independent cohorts. NT-proBNP levels and echocardiographic measurements were collected during hospitalization or ambulatory visits. Quantile regression models were used to assess the independent association between LVEDD and NT-proBNP.
RESULTS: Larger LVEDD was consistently associated with higher NT-proBNP concentrations across the four heart failure cohorts (P < 0.05). This direct linear relationship persisted after multivariable adjustment and across left ventricular ejection fraction categories. A 10 mm increase in LVEDD was associated with an increase in NT-proBNP of 444 pg/mL (95% CI: 266-623, P < 0.001) at admission in the acute heart failure derivation cohort of 158 pg/ml (95% CI: 10-305, P = 0.036) in the chronic heart failure derivation cohort. In the subset of patients in which CMR was performed, CMR-iLVEDV was also positive and linearly associated with NT-proBNP levels. For each 10 ml/m2 increase, NT-proBNP on admission increased by 290 pg/ml (95% CI: 122-458, P < 0.001). Conversely, patients with smaller left ventricular chambers consistently exhibited lower NT-proBNP concentrations.
CONCLUSIONS: Left ventricular chamber size is an independent factor associated with NT-proBNP levels in both acute and chronic heart failure. These findings underscore the importance of incorporating left ventricular dimensions into the interpretation of natriuretic peptide concentrations.