ArticleCirculation2025
Evidence-Based Application of Natriuretic Peptides in the Evaluation of Chronic Heart Failure With Preserved Ejection Fraction in the Ambulatory Outpatient Setting.
Article in Circulation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
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Who cites it
34 citing papers in PubMed.
- Burden of Potentially Undiagnosed Heart Failure With Preserved Ejection Fraction in Atrial Fibrillation and Effects of Catheter Ablation: Insights From CABANA.Journal of the American Heart Association · 2026Trial
- Adaptive blood pressure-modulated atrial pacing in hypertensive HFpEF patients: a randomized, first-in-human study.ESC heart failure · 2026Trial
- HFpEF-ABA Score for the Diagnosis and Prognosis of HFpEF in Outpatients With Type 2 Diabetes.JACC. Advances · 2026Article
- Observational
- HFpEF and MASLD: converging mechanisms and clinical implications.Nature reviews. Cardiology · 2026Review
- Feasibility of a noninvasive photoplethysmography-based wearable chest patch for cardiac output assessment during exercise compared with thermodilution right heart catheterization.Scientific reports · 2026Article
- Understanding HFpEF Through Imaging: Strengths, Limitations, and Current State of the Art.JACC. Cardiovascular imaging · 2026Review
- Effects of Tirzepatide in Obesity-Related HFpEF by Sex: A Prespecified Secondary Analysis From the SUMMIT Trial.JACC. Heart failure · 2026Article
- Metabolic Dysfunction-Associated Steatotic Liver Disease as a Systemic Driver of Heart Failure With Preserved Ejection Fraction: Mechanistic Insights and Emerging Therapeutic Perspectives.Reviews in cardiovascular medicine · 2026Review
- Heart Failure With Mildly Reduced Ejection Fraction: A Heart Failure Society of America Scientific Statement.Journal of cardiac failure · 2026Review
- Validation of NT-proBNP cutoff points for heart failure diagnosis in adults with CHD in the outpatient clinic and emergency department.International journal of cardiology. Congenital heart disease · 2026Article
- Article
- Biomarkers for Screening and Diagnosis of Heart Failure in Cardiovascular-Kidney-Metabolic Syndrome: A Narrative Review.International journal of molecular sciences · 2026Review
- Biomarkers of Cardiac Metabolic Flexibility in Health, HFrEF and HFpEF.International journal of molecular sciences · 2026Review
- Exploring risk factors for new-onset atrial fibrillation in elderly patients with myocardial infarction based on serum NT-proBNP, RDW, Hcy, and clinical parameters: an exploratory study using LASSO-logistic regression.Frontiers in cardiovascular medicine · 2026Article
- NT-proBNP-echocardiographic discordance in type 2 diabetes: links with adiposity and left atrioventricular coupling.Frontiers in endocrinology · 2026Article
- Machine learning-based identification of heart failure with reduced ejection fraction using routine laboratory indicators.Frontiers in cardiovascular medicine · 2026Article
- Finding and Managing Heart Failure Earlier: Why Enhancing Primary Care Teams to Apply More Definitive Surveillance is the Solution.Cardiac failure review · 2026Review
- The global burden of cardiovascular diseases attributable to high body mass index, 1990-2023.Frontiers in cardiovascular medicine · 2026Article
- 2025 Brazilian Evidence-based Guideline on the Management of Obesity and Prevention of Cardiovascular Disease and Obesity-Associated Complications: A Position Statement by Five Medical Societies.Arquivos brasileiros de cardiologia · 2025Article
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11 authors.
Funding
Abstract
backgroundPlasma NT-proBNP (N-terminal pro-B-type natriuretic peptide) is commonly used to diagnose heart failure with preserved ejection fraction (HFpEF), but its diagnostic performance in the ambulatory/outpatient setting is unknown because previous studies lacked objective reference standards.
methodsAmong patients with chronic dyspnea, diagnosis of HFpEF or noncardiac dyspnea was determined conclusively by exercise catheterization in a derivation cohort (n=414), multicenter validation cohort 1 (n=560), validation cohort 2 (n=207), and a nonobese Japanese validation cohort 3 (n=77). Optimal NT-proBNP cut points for HFpEF rule out (optimizing sensitivity) and rule in (optimizing specificity) were derived and tested, stratified by obesity and atrial fibrillation. Derived cut points were tested in 3 additional validation cohorts (cohorts 4-6) in whom HFpEF was diagnosed by resting catheterization only (n=260), previous hospitalization for heart failure (n=447), or exercise echocardiography (n=517), respectively.
resultsCurrent recommended rule-out NT-proBNP threshold <125 pg/mL had 82% sensitivity (95% CI, 77%-88%) with a body mass index (BMI) <35 kg/m
conclusionsIn patients with chronic unexplained dyspnea, current rule-in and rule-out NT-proBNP diagnostic thresholds lead to unacceptably high error rates, with important interactions by obesity and AF status. In our study, NT-proBNP provided little value in those with AF and dyspnea because the presence of AF is by itself a robust biomarker of HFpEF. Use of separate rule-in and rule-out diagnostic thresholds stratified by BMI reduces miscategorization and can guide more appropriate use of exercise testing for possible HFpEF.
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