NT-proBNP in Acute De Novo Heart Failure: A Key Biomarker for Predicting Myocardial Recovery—COMFE Registry

This study aims to analyze whether NT-proBNP at admission and discharge in de novo heart failure (HF) with reduced ejection fraction (HFrEF) is associated with myocardial recovery. This is a prospective observational study in two centers. Patients admitted with de novo HFrEF between 2021 and 2023 were included. HF with improved ejection fraction (HFimpEF) was defined as an improvement of at least 10 points with an ejection fraction >40%. Of the 248 patients who were included, 63.3% met HFimpEF criteria at follow-up, with no differences in age or gender. There were no differences in NT-proBNP at admission, but there were at discharge, where its value was inversely associated with myocardial recovery (OR 0.99 for each increase in the square root of NT-proBNP, 95% CI 0.98-0.99, <i>p</i> = 0.048). An NT-proBNP > 10,000 pg/mL at discharge was independently associated with reduced ventricular recovery (OR 0.28, 95% CI 0.07-0.94, <i>p</i> = 0.043). A smaller reduction in NT-proBNP during admission decreased the probability of recovery (OR 0.13, 95% CI 0.03-0.61, <i>p</i> = 0.010). In conclusion, in admissions for de novo HFrEF, NT-proBNP at discharge is inversely associated with myocardial recovery; a level > 10,000 pg/mL is an independent predictor for a lack of recovery, while a greater reduction increases the likelihood of recovery.