Heart failure with preserved ejection fraction (HFpEF) is often difficult to diagnose and manage because of the lack of a sensitive and specific diagnostic marker. In patients with heart failure with reduced ejection fraction, diagnosis is straightforward by echocardiography, and B-type natriuretic peptide (BNP) is often elevated because of high diastolic wall stress. In patients with HFpEF, however, natriuretic peptide levels are often less than the threshold abnormal values (eg, <100 pg/mL for BNP), owing to the lack of sufficient wall stress stimulus and the well-known effects of obesity (a common HFpEF comorbidity), which is associated with increased BNP clearance and decreased BNP production. Thus, BNP levels are often low in individuals with HFpEF despite high left ventricular filling pressures,1 thereby making diagnosis of HFpEF challenging.
Shah SJ. The Urgent Need for Biomarkers Beyond B-Type Natriuretic Peptide for the Diagnosis and Management of Heart Failure With Preserved Ejection Fraction. JAMA Cardiol. 2018;3(12):1211. doi:https://doi.org/10.1001/jamacardio.2018.3702
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