1*Associate Professor, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: vinodkumar.b@sriramachandra.edu.in. B, MD, DM (Cardio) Fellowship in intravascular imaging (South Korea) FESC; FSCAI; FACC, Sr. Consultant Interventional Cardiologist, Associate Professor, Department of Cardiology, SRIHER. Managing Trustee & Director: C3 Research Foundation, Chennai Cardiac Care
2Associate Professor, Department of Cardiovascular Technology, Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: kgmonisha12@sriramachandra.edu.in
3Associate Professor, Department of Cardiovascular Technology, Faculty of Allied Health Sciences, Vels Institute of Science, Technology and Advanced Studies (VISTAS), Chennai, Tamil Nadu, India. Email: francelavs7@gmail.com
4Associate Professor, Department of Cardiovascular Technology, Faculty of Allied Health Sciences, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Email: jaisrisankar1330@gmail.com
5Senior Resident, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: lalith.kovvuri95@gmail.com
6Associate Professor, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States. Email: rnamakkalsoorappan@uabmc.edu
7Associate Professor, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: k.preetam@sriramachandra.edu.in
8Associate Professor, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: drjvbala@gmail.com
9Professor, Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: sandhyas@sriramachandra.edu.in
10Professor, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. Email: rameshsankaran39@gmail.com
Background: Heart failure (HF) is a multifactorial disorder with a rising global burden, and classification based solely on left ventricular ejection fraction (LVEF) fails to capture the full spectrum of pathophysiological changes, particularly in patients with preserved or mid-range ejection fraction. This study aims to evaluate the combined diagnostic and prognostic utility of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the Heart Failure Echocardiographic Index score criteria (HFEI) in characterizing structural and functional alterations across the HF spectrum.
Methods: This prospective observational study included 90 patients with chronic HF were categorised into three groups: HFrEF (EF <40%), HFmEF (EF 40–49%), and HFpEF (EF ≥50%). Comprehensive echocardiographic assessments and NT-proBNP measurements have been performed. Diastolic dysfunction was graded, and HFEI scores were calculated using an integrative scoring system encompassing systolic function, diastolic parameters, pulmonary pressures, atrioventricular remodeling, and valvular pathology. Statistical comparisons, correlation analyses, and linear regression were conducted to evaluate associations among EF categories, NT-proBNP levels, diastolic dysfunction, and HFEI.
Results: NT-proBNP levels differed significantly among EF categories (p < 0.0001), being highest in HFrEF and lowest in HFpEF. NT-proBNP levels also rose significantly with worsening diastolic dysfunction within HFrEF (p = 0.044) and HFpEF (p = 0.030). HFEI scores showed a strong inverse relationship with LVEF, with median scores of 6 in HFrEF, 4 in HFmEF, and 1 in HFpEF (p < 0.0001). Linear regression confirmed HFEI as a robust indicator of structural disease severity across all EF groups. Diastolic dysfunction was most advanced in HFrEF (Grade III: 46.6%) and mildest in HFpEF (Grade I: 60%).
Conclusion: NT-proBNP and HFEI provide complementary insights into the hemodynamic and structural burden of HF beyond LVEF. Their integration into routine evaluation may enhance phenotyping accuracy, support individualized treatment strategies, and refine prognostic stratification in patients across the HF spectrum. This study reinforces the need for a multiparametric approach to modern HF assessment.
Keywords: NA
How to cite this article: Kumar V, Ganesh M, Damodaran L, Sankar J, Kovvuria HL, Soorappan RN, Krishnamurthya P, Venkataa BJ, Sundaram S, Sankarana R. Beyond Ejection Fraction: Synergistic Role of NT-proBNP and The Heart Failure Echocardiographic Index in Phenotyping Structural and Functional Burden in Heart Failure. Int J Drug Deliv Technol. 2026;16(16s): 56-64. DOI: 10.25258/ijddt.16.16s.7
Source of support: Nil.
Conflict of interest: None