Changes in N-Terminal Pro-B-Type Natriuretic Peptide Levels According to Estimated Plasma Volume Variation in Patients with Acute Decompensated Heart Failure
Keywords:
Estimated plasma volume variation, NT-proBNP, ADHF
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.
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References
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26. Popat A, Yadav S, Pethe G, Rehman A, Sharma P, Rezkalla S. The role of POCUS in diagnosing acute heart failure in the emergency department: A Meta-analysis. Journal of Cardiology. 2025.
27. Benjamin MM, Bianco C, Caccamo M, Sokos G, Kagiyama N, Shrestha S, et al. Non-invasive prediction of tissue Doppler-derived E/e′ ratio using lung Doppler signals. European Heart Journal-Cardiovascular Imaging. 2020;21(9):994-1004.
28. Polovina, M., Tomić, M., Janković, M., Civrić, D., Stojićević, A., Stanković, S., Pejović, T., Viduljević, M., Krljanac, G., Ašanin, M., Stanković, S., & Seferović, P. M. (2026). Impact of Predischarge NT-proBNP on Treatment Optimisation in Acute Heart Failure. International Journal of Molecular Sciences, 27(2), 1028. https://doi.org/10.3390/ijms27021028Pena D-L, Ilieșiu A-M, Aurelian J, Grigore M, Hodorogea A-S, Ciobanu A, et al. Assessment of Decongestion Status Before Discharge in Acute Decompensated Heart Failure: A Review of Clinical, Biochemical, and Imaging Tools and Their Impact on Management Decisions. Medicina. 2025;61(5):816.
29. George J, Wilson Tang WH. Evolving Decongestion Strategies in the Management of Acute Heart Failure. Curr Treat Options Cardiovasc Med. 2025;27(1):71. doi: 10.1007/s11936-025-01125-y. Epub 2025 Oct 18. PMID: 41116865; PMCID: PMC12535541.
30. Grigore, M., Nicolae, C., Grigore, A.-M., Balahura, A.-M., Păun, N., Uscoiu, G., Verde, I., & Ilieșiu, A.-M. (2025). Contemporary Perspectives on Congestion in Heart Failure: Bridging Classic Signs with Evolving Diagnostic and Therapeutic Strategies. Diagnostics, 15(9), 1083. https://doi.org/10.3390/diagnostics15091083
2. Harjola, V.-P., Follath, F., Nieminen, M.S., Brutsaert, D., Dickstein, K., Drexler, H., Hochadel, M., Komajda, M., Lopez-Sendon, J.L., Ponikowski, P. and Tavazzi, L. (2010), Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. European Journal of Heart Failure, 12: 239-248. https://doi.org/10.1093/eurjhf/hfq002.
3. Njoroge JN, Teerlink JR. Pathophysiology and therapeutic approaches to acute decompensated heart failure. Circulation research. 2021;128(10):1468-86.
4. Tubaro M, Vranckx P, Price S, Vrints C, Bonnefoy E. The ESC textbook of intensive and acute cardiovascular care: Oxford University Press; 2021.
5. Niluh CE, Rampengan SH, Jim EL. Gambaran penyakit jantung koroner pada pasien gagal jantung yang menjalani rawat inap di RSUP Prof. Dr. RD Kandou Manado periode September-November 2016. e-CliniC. 2016;4(2).
6. Kobayashi M, Girerd N, Duarte K, Chouihed T, Chikamori T, Pitt B, et al. Estimated plasma volume status in heart failure: clinical implications and future directions. Clinical Research in Cardiology. 2021:1-14.
7. Kobayashi M, Huttin O, Donal E, Duarte K, Hubert A, Le Breton H, et al. Association of estimated plasma volume status with hemodynamic and echocardiographic parameters. Clinical Research in Cardiology. 2020;109:1060-9.
8. Yang X, Zhang F, Zhan Y, Liu Z, Wang W, Shi J. Association between estimated plasma volume status and acute kidney injury in patients who underwent coronary revascularization: A retrospective cohort study from the MIMIC-IV database. Plos one. 2024;19(6):e0300656.
9. Savarese G, Trimarco B, Dellegrottaglie S, Prastaro M, Gambardella F, Rengo G, et al. Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PloS one. 2013;8(3):e58287
10. Grigore A-M, Grigore M, Balahura A-M, Uscoiu G, Verde I, Nicolae C, et al. The Role of the Estimated Plasma Volume Variation in Assessing Decongestion in Patients with Acute Decompensated Heart Failure. Biomedicines. 2025;13(1):88.
11. Almufleh A, Desai AS, Fay R, Ferreira JP, Buckley LF, Mehra MR, et al. Correlation of laboratory haemoconcentration measures with filling pressures obtained via pulmonary arterial pressure sensors in ambulatory heart failure patients. European Journal of Heart Failure. 2020;22(10):1907-11.
12. Tsutsui H, Albert NM, Coats AJ, Anker SD, Bayes-Genis A, Butler J, et al. Natriuretic peptides: role in the diagnosis and management of heart failure: a scientific statement from the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. Journal of Cardiac Failure. 2023;29(5):787-804.
13. Kobayashi M, Rossignol P, Ferreira JP, Aragão I, Paku Y, Iwasaki Y, et al. Prognostic value of estimated plasma volume in acute heart failure in three cohort studies. Clinical Research in Cardiology. 2019;108:549-61.
14. Khan SS, Beach LB, Yancy CW. Sex-based differences in heart failure: JACC Focus Seminar 7/7. Journal of the American College of Cardiology. 2022;79(15):1530-41.
15. Kirsch H, Hashemzadeh M, Movahed MR. Age-adjusted trends in the diastolic and systolic heart failure in the United States over recent years based on race and gender with higher trends in Men and African Americans. medRxiv. 2025:2025.08. 01.25332699.
16. Tromp J, Ouwerkerk W, Cleland JG, Angermann CE, Dahlstrom U, Tiew-Hwa Teng K, et al. Global differences in burden and treatment of ischemic heart disease in acute heart failure: REPORT-HF. Heart Failure. 2021;9(5):349-59.
17. Al-Jarallah M, Rajan R, Heshmat H, Al-Zakwani I, Dashti R, Bulbanat B, et al. Comparison of demographics and outcomes of acute heart failure patients with reduced, mid-range, and preserved ejection fraction. Annals of Clinical Cardiology. 2020;2(2):86-94.
18. Alalawi H, Fida HL, Bokhary OA, Alhuzali MA, Alharbi AF, Alhodian FY, et al. Demographics and characteristics of acutely decompensated heart failure (ADHF) patients in a Tertiary Care Center in Saudi Arabia. Cureus. 2023;15(3).
19. Polovina M, Tomić M, Viduljević M, Zlatić N, Stojićević A, Civrić D, et al. Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure. Frontiers in Cardiovascular Medicine. 2023;10:1254306.
20. Gentile F, Chianca M, Bazan L, Sciarrone P, Chubuchny V, Taddei C, et al. Incremental prognostic value of echocardiography measures of right ventricular systolic function in patients with chronic heart failure. Journal of the American Heart Association. 2025;14(5):e038616.
21. Sinha SS, Morrow DA, Kapur NK, Kataria R, Roswell RO. 2025 Concise Clinical Guidance: an ACC expert consensus statement on the evaluation and management of cardiogenic shock: a report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2025;85(16):1618-41.
22. Frea S, Gravinese C, Boretto P, De Lio G, Bocchino PP, Angelini F, et al. Comprehensive non-invasive haemodynamic assessment in acute decompensated heart failure-related cardiogenic shock: a step towards echodynamics. European Heart Journal: Acute Cardiovascular Care. 2024;13(9):646-55.
23. Oh J, Kang S-M, Hong N, Youn J-C, Han S, Jeon E-S, et al. Hemoconcentration is a good prognostic predictor for clinical outcomes in acute heart failure: data from the Korean Heart Failure (KorHF) Registry. International journal of cardiology. 2013;168(5):4739-43.
24. Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes care. 2006;29(12):2739-48.
25. Uchiyama S, Toki M, Kitai T, Yoshioka K, Hayashida A, Yoshida K, et al. Dynamic changes in echocardiographic parameters in acute decompensated heart failure: REALITY-ECHO. Journal of Cardiology. 2024;83(4):258-64.
26. Popat A, Yadav S, Pethe G, Rehman A, Sharma P, Rezkalla S. The role of POCUS in diagnosing acute heart failure in the emergency department: A Meta-analysis. Journal of Cardiology. 2025.
27. Benjamin MM, Bianco C, Caccamo M, Sokos G, Kagiyama N, Shrestha S, et al. Non-invasive prediction of tissue Doppler-derived E/e′ ratio using lung Doppler signals. European Heart Journal-Cardiovascular Imaging. 2020;21(9):994-1004.
28. Polovina, M., Tomić, M., Janković, M., Civrić, D., Stojićević, A., Stanković, S., Pejović, T., Viduljević, M., Krljanac, G., Ašanin, M., Stanković, S., & Seferović, P. M. (2026). Impact of Predischarge NT-proBNP on Treatment Optimisation in Acute Heart Failure. International Journal of Molecular Sciences, 27(2), 1028. https://doi.org/10.3390/ijms27021028Pena D-L, Ilieșiu A-M, Aurelian J, Grigore M, Hodorogea A-S, Ciobanu A, et al. Assessment of Decongestion Status Before Discharge in Acute Decompensated Heart Failure: A Review of Clinical, Biochemical, and Imaging Tools and Their Impact on Management Decisions. Medicina. 2025;61(5):816.
29. George J, Wilson Tang WH. Evolving Decongestion Strategies in the Management of Acute Heart Failure. Curr Treat Options Cardiovasc Med. 2025;27(1):71. doi: 10.1007/s11936-025-01125-y. Epub 2025 Oct 18. PMID: 41116865; PMCID: PMC12535541.
30. Grigore, M., Nicolae, C., Grigore, A.-M., Balahura, A.-M., Păun, N., Uscoiu, G., Verde, I., & Ilieșiu, A.-M. (2025). Contemporary Perspectives on Congestion in Heart Failure: Bridging Classic Signs with Evolving Diagnostic and Therapeutic Strategies. Diagnostics, 15(9), 1083. https://doi.org/10.3390/diagnostics15091083
Published
2026-09-08
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How to Cite
Prisilla, W., Ilhami, Y., Krevani, C., & Ali, H. (2026). Changes in N-Terminal Pro-B-Type Natriuretic Peptide Levels According to Estimated Plasma Volume Variation in Patients with Acute Decompensated Heart Failure. Indonesian Journal of Cardiology. https://doi.org/10.30701/ijc.1934
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