Use of an individual NT-proBNP value calculator in the diagnosis of heart failure with preserved ejection fraction

Aim. To develop an online calculator of individual NT-proBNP thresholds to diagnose heart failure with preserved ejection fraction (HFpEF) and to pilot it in clinical practice.

Material and methods. At the first stage, an online calculator that computes a personalised NT-proBNP threshold based on age, sex, body mass index (BMI), estimated glomerular filtration rate (CKD-EPI), and the presence of atrial fibrillation was developed. A total of 128 patients (50% women; median age, 71 years) with HFpEF hospitalised at University Clinical Hospital No. 1, Sechenov University, between January and August 2024 were enrolled to validate the calculator. Diagnoses based on guideline-recommended NT-proBNP cutoffs were compared with diagnoses incorporating individualised thresholds from the calculator. Agreement between methods was assessed using Cohen’s kappa, and differences in diagnosis rates were evaluated with McNemar’s test.

Results. When comparing diagnoses based on standard NT-proBNP thresholds with those using individualised values, the diagnosis changed in 38 cases (29.7%): HFpEF was established in 30 patients and excluded in 8. Cohen’s kappa was 0.35. The difference between approaches was statistically significant (p=0.0005). The greatest diagnostic discrepancies were observed in patients younger than 60 years and in those with BMI 30-34 kg/m² and ≥40 kg/m²; statistically significant differences in diagnosis frequency were found only for patients with BMI 30-34 kg/m² (k=0.38, p <0.001). The minimum and maximum calculated NT-proBNP thresholds were 45 pg/mL and 506 pg/mL, respectively, delineating a “gray zone” in which the calculator may be particularly useful for refining diagnosis.

Conclusion. NT-proBNP remains a key biomarker in HFpEF diagnosis; however, patient sex, age, and comorbidities affect its circulating levels. We therefore propose using our online calculator to derive individualized NT-proBNP thresholds for HFpEF diagnosis to reduce diagnostic errors, initiate treatment in a timely manner, and avoid unnecessary medication.

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