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In patients suspected of having HFpEF, two key diagnostic markers — NT-proBNP (a blood biomarker) and left ventricular filling pressure — disagreed in over 40% of cases. Elevated NT-proBNP was linked to significantly higher mortality risk, while high filling pressure alone was not. The findings suggest combining both measures could sharpen how doctors identify and risk-stratify these patients.
Heart failure with preserved ejection fraction (HFpEF) is notoriously tricky to diagnose, and a new study published in Heart adds another layer of complexity: two of its most commonly used diagnostic markers often tell different stories. In a prospective cohort of 514 patients suspected of having HFpEF, NT-proBNP (a blood-based biomarker) and left ventricular end-diastolic pressure (LVEDP, a measure of heart filling pressure) were discordant in more than 40% of cases.
The stakes of that disagreement are real. Elevated NT-proBNP was associated with a 2.26-fold higher risk of death, and when both markers were elevated, the risk jumped to 3.33-fold. High LVEDP alone, however, showed no significant link to mortality — a finding that challenges assumptions about using invasive pressure measurements as a standalone risk tool.
By the Numbers:
Why it matters: For clinicians managing HFpEF, these findings suggest that NT-proBNP carries stronger prognostic weight than resting filling pressure alone. Integrating both biomarker and hemodynamic data could improve patient phenotyping and risk stratification — though the researchers caution that external validation is still needed.
