Validation of N-Terminal Pro B-Type Natriuretic Peptide Threshold for Early Detection of Pre-Heart Failure in a General Japanese Population　― Toon Health Study ―

Abstract

Background: An N-terminal pro B-type natriuretic peptide (NT-proBNP) level above 125 pg/mL has been suggested as a universal marker for heart failure (HF). Furthermore, the Japanese Heart Failure Society (JHFS) advises follow-up when NT-proBNP exceeds 55 pg/mL, even if it remains below 125 pg/mL, for early HF detection. However, evidence supporting these thresholds remains limited.

Methods and Results: This prospective study, part of the Toon Health Study, included 573 participants with NT-proBNP levels below 125 pg/mL. Pre-HF progression was defined as reaching NT-proBNP levels of 125 pg/mL or higher after 5 years. The median age of the 573 participants was 61 years, and 70% were female. After 5 years, 53 (9.2%) participants developed pre-HF. Higher baseline NT-proBNP was associated with increased progression to pre-HF. A receiver operating characteristic curve identified 52.4 pg/mL NT-proBNP as the optimal threshold for predicting pre-HF progression, with an area under the curve of 0.78.

Conclusions: Even if NT-proBNP levels are below 125 pg/mL, especially when exceeding 52.4 pg/mL, close monitoring may be needed due to the risk of future pre-HF. These findings could support the JHFS’s recommendation.