BACKGROUND: In heart failure (HF) patients with a higher left ventricular ejection fraction (LVEF), the B-type natriuretic peptide (BNP) level is yet to be fully assessed. Accordingly, we hypothesized that the BNP level should be higher in patients with a higher LVEF range based on the previous finding that such patients were associated with a worse prognosis. METHODS AND RESULTS: In our multicenter, prospective, observational cohort for the composite endpoint of all-cause death and readmission due to HF, including patients with LVEF >
40% at hospital discharge, we obtained LVEF, E/e', and BNP levels in 231 patients. The concurrent atrial fibrillation (AF) was confirmed by electrocardiogram. Patients were divided into HF with mildly reduced EF (HFmrEF), HF with preserved EF (HFpEF) with LVEF ≥50 and <
60%, and HFpEF with LVEF ≥60%. The BNP levels were not significantly different among these groups (median [interquartile range]: 195 [110-348] vs. 242 [150-447] vs. 220 [125-320] pg/mL, respectively
P=0.422). In contrast, a BNP level of ≥377 pg/mL could significantly differentiate event-free survival (P<
0.001). In the multi-covariate Cox proportional hazards model, the BNP level was significantly related to event-free survival independent of LVEF, E/e', and concurrent AF. CONCLUSIONS: Without confounding the effects of LVEF, E/e', and concurrent AF, higher BNP levels are significantly and independently associated with event-free survival in HF patients with LVEF>
40%.