Cardiac Overload and Heart Failure Risk by NT-proBNP Levels in Older Adults with COPD Eligible for Single-Inhaler Triple Therapy - A Multicenter Longitudinal Study

Q: What was the study’s primary aim regarding NT-proBNP in older adults with COPD?

To assess the prevalence of cardiac overload and heart failure (HF) risk using NT-proBNP in older COPD patients eligible for single-inhaler triple therapy and without a history of overt HF.

Q: How were cardiac overload and HF risk categorized in the study?

Patients were stratified using age- and comorbidity-adjusted NT-proBNP thresholds based on the 2023 Heart Failure Association (HFA) Clinical Consensus Statement of the ESC.

Q: What change in NT-proBNP was observed after 3 months of single-inhaler triple therapy?

NT-proBNP significantly decreased by 7.2% after 3 months of SITT, with the largest reductions reported in younger patients.

Sep 30, 2026

Uploaded by Mimi

Cardiac overload is frequently overlooked in older patients with chronic obstructive pulmonary disease (COPD), despite its major influence on outcomes and mortality. This multicenter longitudinal observational study evaluates the prevalence of cardiac overload and heart failure (HF) risk using N-terminal pro-B-type natriuretic peptide (NT-proBNP) in older COPD outpatients eligible for single-inhaler triple therapy (SITT) without known overt HF, and assesses NT-proBNP changes after 3 months. Results show a substantial proportion with NT-proBNP levels consistent with HF likely and very high-risk, alongside a significant biomarker reduction after SITT.

LanguageEnglish

CategoryHealthcare

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Pages14

Reading Time35 min

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Abstract

Introduction

Article Cardiac Overload and Heart Failure Risk by NT-proBNP Levels in Older Adults with COPD Eligible for Single-Inhaler Triple Therapy: A Multicenter Longitudinal Study Riccardo Sarzani 1,2,†, Francesco Spannella 1,2,†, Giorgia Laureti 1,2, Piero Giordano 1, Federico Giulietti 1,2,*, Alessandro Gezzi 1,2, Pier-Valerio Mari 3, Angelo Coppola 4, Roberta Galeazzi 5, Yuri Rosati 6, Erilda Kamberi 6, Andrea Stronati 7, Alessia Resedi 8 and Matteo Landolfo 1,2 Academic Editors: Myriam Calle Rubio, Juan Luis Rodriguez Hermosa and José Luis Álvarez-Sala Walther Received: 14 November 2025 Revised: 21 December 2025 Accepted: 28 December 2025 Published: 30 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, AN, Italy; [r.sarzani@univpm.it](r.sarzani@univpm.it) (R.S.); [f.spannella@univpm.it](f.spannella@univpm.it) (F.S.) 2 Clinical and Molecular Sciences Department,“Politecnica delle Marche” University, 60126 Ancona, AN, Italy 3 Internal Medicine, San Carlo di Nancy Hospital, 00165 Rome, RM, Italy 4 Pulmonary Medicine, San Filippo Neri Hospital, 00135 Rome, RM, Italy 5 Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60127 Ancona, AN, Italy 6 Pneumology Unit, IRCCS INRCA, 60027 Osimo, AN, Italy 7 Medicine Unit, AST Marche, 60025 Loreto, AN, Italy 8 Pneumology Unit, AST Marche, 60035 Jesi, AN, Italy * Correspondence: [f.giulietti@inrca.it](f.giulietti@inrca.it) † These authors contributed equally to this work and should be considered co-first authors. Abstract Background: In common clinical practice, cardiac overload is still often overlooked inpatients with chronic obstructive pulmonary disease (COPD) despite its substantial impact on clinical outcomes and mortality. This study aimed to assess the prevalence of cardiac overload and heart failure (HF) risk, using N-terminal pro-B-type natriuretic peptide (NT-proBNP), in older COPD patients eligible for single-inhaler triple therapy (SITT) and without history of overt HF. We also evaluated changes in NT-proBNP after 3 months of SITT. Methods: This multicenter observational study included 165 older outpatients with a recent moderate-to-severe acute exacerbation of COPD (AECOPD), categorized as ‘Group E’ according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) . Patients were stratified for the presence of cardiac overload and HF risk using ageand comorbidity-adjusted NT-proBNP thresholds, as recommended by the 2023 Clinical Consensus Statement of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). NT-proBNP was measured at baseline and after three months of SITT (116 patients with available test at three months) . Results: Mean age was 80.7 ± 9.7 years. Patients with NT-proBNP levels indicative of “HF likely” and “HF very high-risk” were 43.0% and 24.2%, respectively. After 3 months of SITT, NT-proBNP significantly decreased by 7.2%(95%CI 9.0–5.4%, p < 0.001), with the largest reductions observed in younger patients [11.0%(95% CI 14.1–7.2%) ≤ 76 years old, 8.4%(95% CI −11.3–5.5%) in 77–87 years old, −3.0%(95% CI −6.1–0.0%) in ≥88 years old, p for interaction = 0.007] . Conclusions: In real-life clinical practice, a substantial proportion of older patients with GOLD Group E COPD had elevated NT-proBNP, suggestive of cardiac overload and high risk of HF. The early identification of these patients may prompt further cardiologic evaluation and management. After SITT and before cardiology evaluation, a significant NT-proBNP reduction has been observed, suggesting potential cardiovascular benefit of SITT. Keywords: NT-proBNP; COPD; cardiac overload; heart failure; triple inhaled therapy; SITT 1. Introduction Chronic obstructive pulmonary disease (COPD) and its a

FAQs

What was the study’s primary aim regarding NT-proBNP in older adults with COPD?

To assess the prevalence of cardiac overload and heart failure (HF) risk using NT-proBNP in older COPD patients eligible for single-inhaler triple therapy and without a history of overt HF.

How were cardiac overload and HF risk categorized in the study?

Patients were stratified using age- and comorbidity-adjusted NT-proBNP thresholds based on the 2023 Heart Failure Association (HFA) Clinical Consensus Statement of the ESC.

What change in NT-proBNP was observed after 3 months of single-inhaler triple therapy?

NT-proBNP significantly decreased by 7.2% after 3 months of SITT, with the largest reductions reported in younger patients.

Sep 30, 2026

Uploaded by Mimi