Background
B-type natriuretic peptide (BNP) is a well-known
biomarker for prognosis in
heart failure with patients with preserved ejection fraction. However, the clinical predictive ability of BNP for the risk of
stroke in HFpEF is not clear. Methods and Results A total of 799 patients with HFpEF from the TOPCAT (Treatment of Preserved Cardiac Function
Heart Failure With an
Aldosterone Antagonist) trial were included. Association of baseline BNP with risk of
stroke was assessed using the Cox proportional hazard model. The discriminatory ability of BNP was expressed using the C index. The improvement in 5-year
stroke prediction was assessed by C statistic, categorical net reclassification improvement index, and relative integrated discrimination improvement. A total of 34 (4.3%) patients among the 799 patients with HFpEF experienced
stroke events over a median of 2.85 years of follow-up. The
stroke group showed a higher BNP level than the nonstroke group (375 pg/mL versus 241 pg/mL, respectively; P=0.006). Higher BNP levels were associated with increased risk of
stroke after multivariable adjustment (hazard ratio, 3.29 [95% CI, 1.51-7.16]) and had a moderate performance for
stroke prediction (C index, 0.67). Adding BNP to CHADS2/CHA2DS2-VASc/R2CHADS2 scores improved their predictive value for
stroke (CHADS2: C index, 0.67; BNP+CHADS2: C index, 0.77; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.0%; CHA2DS2-VASc: C index, 0.64; BNP+CHA2DS2-VASc: C index, 0.74; net reclassification improvement, 41.4%; integrated discrimination improvement, 2.2%; R2CHADS2: C index, 0.70; BNP+R2CHADS2: C index, 0.78; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.2%). Conclusions BNP is associated with an increased risk of
stroke in patients with HFpEF and may be a valuable
biomarker for
stroke prediction in HFpEF.