Changes in N-Terminal Pro-B-Type Natriuretic Peptide Levels According to Estimated Plasma Volume Variation in Patients with Acute Decompensated Heart Failure

Abstract

Background: Acute Decompensated Heart Failure (ADHF), often caused by fluid retention and elevated left ventricular filling pressure, is the most common form of acute heart failure, accounting for 50-70% of cases. It carries high morbidity and mortality, with in-hospital death up to 11% and one-year post-discharge mortality reaching 36%. Rehospitalization rates range from 22-30% within 1-3 months to 65% within one year. In Indonesia, the 2013 prevalence of physician-diagnosed heart failure was 0.13%, affecting approximately 230,000 people. Methods: This prospective observational study was conducted on ADHF patients admitted to the Cardiology Department of Dr. M. Djamil General Hospital, Padang, during July-August 2025. Blood and N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) assessments were obtained at admission and upon discharge. Participants were divided into two categories based on their estimated Plasma Volume Variation (ePVV) results (<0% and ≥0%). The Mann-Whitney test was used to compare NT-proBNP variations between these groups. Results: A total of 33 participants were included, the majority being male, with pneumonia as the most prevalent comorbidity and ischemic heart disease as the primary underlying cause. Patients with ePVV <0% showed a median change in NT-proBNP of 21.06%, whereas those with ePVV ≥0% showed a median change of 9.58%. The Mann-Whitney test indicated that this difference between groups was statistically significant (p = 0.012). Conclusion: The observed variation in NT-proBNP levels across ePVV categories suggests that ePVV may be a valuable non-invasive marker for assessing congestion status in ADHF. Combining ePVV measurements with NT-proBNP monitoring could enhance clinical assessment and management strategies for patients with heart failure.