Background: B-type natriuretic peptide (BNP) is an important biomarker in heart failure with reduced ejection fraction (HFrEF). We aimed to explore changes in BNP and their relationship with long-term dynamics of left ventricular (LV) geometry.
Methods: This was a single-center retrospective cohort. Inclusion criteria included LV ejection fraction (LVEF) < 40% measured by echocardiography, BNP ≥100 pg/mL at baseline, and a subsequent BNP measure within a year. Percent BNP change from baseline was computed and divided into tertiles. Percent change tertiles represented decreasing (min-max, -63.3 to -10.4), minimal changes (-10.4 to 2.8), and rising BNP levels (2.9 to 12.6). The study endpoint included LV internal dimension at end-systole (LVIDs), LV internal dimension at end-diastole (LVIDd), and LVEF. The secondary endpoint consisted of all-cause mortality.
Results: A total of 887 patients were included. Baseline characteristics, including age, sex, blood pressure, atrial fibrillation, baseline BNP, and LVEF, varied among tertiles (p < 0.05). When comparing to the rising BNP tertile, the decreasing BNP tertile showed decreased trends of LVIDs (p = 0.001), LVIDd (p = 0.006); and increased trends of LVEF (p = 0.008). All-cause mortality was higher in the rising BNP tertile (p < 0.05) compared to the decreasing tertile.
Conclusion: In a real-world routine HFrEF cohort, this study demonstrates the time-dependent relationship between BNP changes, LV remodeling dynamics, and survival outcomes. Findings contribute to the literature supporting BNP as a dynamic marker for LV remodeling.
Keywords: BNP; HFrEF; LVEF; longitudinal; remodeling.
© 2026 Romero, Kushnir, Shahzad, Patel, Heejung, Sirish, Chiamvimonvat, Liem and Cadeiras.