Measurement of plasma natriuretic peptides may support PH screening in HFrEF, but their limited ability to detect severe precapillary component confirms RHC as the definitive tool for hemodynamic phenotyping.
Pulmonary hypertension was present in 443 out of 563 HFrEF patients who underwent right heart catheterization.
Patients with PH had significantly higher BNP and NT-proBNP levels compared to those without PH.
Increases in PH risk and hemodynamic parameters were associated with rising BNP up to approximately 500 pg/mL and NT-proBNP up to approximately 3000 pg/mL.
BNP and NT-proBNP were independent predictors of PH and PVR greater than 5 Wood units.
Natriuretic peptides predicted the presence of PH with moderate accuracy but were less accurate for identifying severe precapillary hemodynamic components.
This research investigated whether two blood biomarkers — BNP and NT-proBNP, which are proteins released by the heart under stress — could help identify pulmonary hypertension (high blood pressure in the lungs) in patients with heart failure with reduced ejection fraction (HFrEF). The study looked back at records from 563 such patients who had all undergone right heart catheterization (RHC), the gold-standard but invasive procedure for diagnosing this condition. Nearly 79% of these patients had pulmonary hypertension, and those who did had significantly higher levels of both biomarkers. The study found that both BNP and NT-proBNP could predict whether a patient had pulmonary hypertension with moderate accuracy — BNP performed better (AUC 0.798) than NT-proBNP (AUC 0.727). However, both biomarkers were much less accurate at identifying patients with more severe forms of the disease, specifically those with high pulmonary vascular resistance (a marker of vascular remodeling) or very low cardiac output. The association between rising biomarker levels and worsening lung pressures appeared to plateau around 500 pg/mL for BNP and 3000 pg/mL for NT-proBNP, suggesting diminishing informational value at very high levels. This research suggests that measuring natriuretic peptides in the blood could help doctors decide which heart failure patients need further invasive testing for pulmonary hypertension, potentially prioritizing higher-risk individuals for catheterization. However, because these biomarkers cannot reliably distinguish the most severe or complex forms of the disease, they cannot replace invasive right heart catheterization for fully characterizing a patient's hemodynamic status. The findings support a role for these biomarkers as a screening tool, not a diagnostic replacement.
Sawczak F, Kukfisz A, Soloch A, Kurkiewicz-Sawczak K, Dudek M, Straburzyńska-Migaj E, et al.. (2026). Natriuretic Peptides as Predictors for the Diagnosis of Pulmonary Hypertension Secondary to Left Heart Disease and for the Assessment of Its Severity.. International journal of molecular sciences. https://doi.org/10.3390/ijms27177776