Usefulness of B‐Type Natriuretic Peptide for Predicting the Risk of Stroke in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Background B‐type natriuretic peptide (BNP) is a well‐known biomarker for prognosis in heart failure with patients with preserved ejection fraction. However, the clinical predictive ability of BNP for the risk of stroke in HFpEF is not clear. Methods and Results A total of 799 patients with HFpEF from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial were included. Association of baseline BNP with risk of stroke was assessed using the Cox proportional hazard model. The discriminatory ability of BNP was expressed using the C index. The improvement in 5‐year stroke prediction was assessed by C statistic, categorical net reclassification improvement index, and relative integrated discrimination improvement. A total of 34 (4.3%) patients among the 799 patients with HFpEF experienced stroke events over a median of 2.85 years of follow‐up. The stroke group showed a higher BNP level than the nonstroke group (375 pg/mL versus 241 pg/mL, respectively; P =0.006). Higher BNP levels were associated with increased risk of stroke after multivariable adjustment (hazard ratio, 3.29 [95% CI, 1.51–7.16]) and had a moderate performance for stroke prediction (C index, 0.67). Adding BNP to CHADS 2 /CHA 2 DS 2 ‐VASc/R 2 CHADS 2 scores improved their predictive value for stroke (CHADS 2 : C index, 0.67; BNP+CHADS 2 : C index, 0.77; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.0%; CHA 2 DS 2 ‐VASc: C index, 0.64; BNP+CHA 2 DS 2 ‐VASc: C index, 0.74; net reclassification improvement, 41.4%; integrated discrimination improvement, 2.2%; R 2 CHADS 2 : C index, 0.70; BNP+R 2 CHADS 2 : C index, 0.78; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.2%). Conclusions BNP is associated with an increased risk of stroke in patients with HFpEF and may be a valuable biomarker for stroke prediction in HFpEF.