Clinical and echocardiographic characteristics of elderly hospitalized patients with high levels of NT-proBNP without clinical diagnosis of heart failure

Background Patients with high NT-proBNP levels but without heart failure (HF) diagnosis have a higher risk of cardiovascular events and mortality; however, there are few data about their characteristic, especially in the elderly. Aims To compare the clinical and echocardiographic characteristics of elderly hospitalized patients with and without increased NT-proBNP and with and without a diagnosis of HF. Methods We reviewed 209 charts of patients admitted to an acute care ward (mean age 78.9 years, SD 10.2, 62 % women). We classified the patients into four groups: no HF with or without increased (>900 pg/mL) NT-proBNP (HF−/BNP−, N = 89 and HF−/BNP+, N = 41), and HF with or without increased NT-proBNP (HF+/BNP−, N = 4 and HF+/BNP+, N = 75). The groups were compared with respect to demographic and clinical characteristics, symptoms at admission, comorbidities, echocardiographic parameters, and cardiovascular events at 180 days. Results Patients in the groups HF+/BNP+ and HF−/BNP+ were older, with higher serum creatinine, blood urea nitrogen, and lower serum hemoglobin compared to patients in the HF−/BNP− group. The prevalence of ischemic heart disease, pulmonary hypertension, and atrial fibrillation progressively decreased across the HF+/BNP+, HF−/BNP+, and HF−/BNP− groups. The prevalence of abnormal echocardiographic findings in the HF−/BNP+ group was intermediate compared to the other two groups for severe aortic or mitralic regurgitation, monophasic transmitralic pattern, biatrial atriomegaly, ejection fraction, akinesia extension, and PAPs. The same pattern was observed for cardiovascular events at follow-up. Discussion Elderly patients without a diagnosis of HF, but with high NT-proBNP serum concentration have intermediate clinical characteristics compared to the other two groups. Conclusion NT-proBNP may be a useful marker of silent cardiac damage.