Comparison of Plasma N-Terminal Pro-B-Type Natriuretic Peptide Levels Between European and Japanese Patients with Acute Heart Failure: An International Study

Plasma biomarkers levels, essential for diagnosing cardiovascular diseases, may vary by ethnicity. In this international prospective study, we compared plasma biomarker levels between European and Asian patients with clinically similar acute heart failure (AHF). Data were collected on emergency admission for acute dyspnea. Blood samples were obtained within 4 hrs of presentation and analyzed for N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin-T, growth differentiation factor 15, interleukin-6, and C-reactive protein levels. Overall, 907 AHF patients were enrolled; of which, 135 (15%) were Japanese, and 772 (85%) were European. NT-proBNP levels were significantly higher in Japanese than in Europeans [4,060 ng/L (interquartile range (IQR) 2,081-12,218) vs. 3,390 ng/L (IQR 1,410-7,682), <i>P</i> =0.004]. After propensity score matching (PSM), no biomarker levels differed significantly. After stratification according to left ventricular ejection fraction (LVEF) at admission, higher NT-proBNP levels were observed in Japanese AHF patients with LVEF > 50% (<i>P</i> =0.02) than in European patients. After PSM, the difference was insignificant (<i>P</i> =0.35). In Asian and Caucasian AHF patients with similar clinical profiles, plasma cardiovascular biomarker levels did not differ significantly, regardless of LVEF, suggesting that NT-proBNP and related biomarkers can be applied across these ethnicities.