ArticleJournal of the American Heart Association2026
Combined Prognostic Value of Follow-Up Ejection Fraction and Natriuretic Peptide Measurements in Heart Failure With Reduced Ejection Fraction Following Initiation of Pharmacotherapy.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFew studies have directly compared the prognostic value of left ventricular ejection fraction (LVEF) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) in patients with heart failure (HF) with reduced EF who have initiated guideline-directed medical therapy. This study sought to assess the combined prognostic value of follow-up LVEF and NT-proBNP measurements taken following initiation of guideline-directed medical therapy in patients with HF with reduced EF.
methodsThis retrospective cohort study (2009-2024) conducted at a large, integrated health system included 6168 patients who had a diagnosis of HF with reduced EF (LVEF ≤40%) along with available LVEF and NT-proBNP measurements at ~9 months following diagnosis, which was defined as the study baseline. A composite outcome of HF hospitalization or all-cause death was assessed.
resultsA large majority of patients were on at least 2 guideline-directed medical therapy medications at baseline. The median LVEF was 36% (interquartile range, 27-46), and the median NT-proBNP was 2161 pg/mL (interquartile range, 610-7350). Higher NT-proBNP levels were, in general, associated with a higher adjusted 1-year risk of the composite outcome across the spectrum of LVEF, with even mildly to moderately elevated NT-proBNP levels (125-1000 pg/mL) associated with incremental risk. Both LVEF and NT-proBNP offered independent prognostic information, but NT-proBNP had a much stronger association with the composite outcome and a much greater ability to discriminate between patients based on risk than LVEF (Δconcordance index: +0.129; 95% CI, 0.118-0.141), with LVEF offering only minimal prognostic value beyond NT-proBNP.
conclusionsAmong patients with HF with reduced EF who have initiated guideline-directed medical therapy, NT-proBNP may offer much greater prognostic value than LVEF, with even mildly to moderately elevated NT-proBNP levels portending meaningful incremental risk.
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