Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction

• Published in: Journal of the American College of Cardiology Vol. 74; no. 9; pp. 1205 - 1217
• Main Authors: Januzzi, James L., Ahmad, Tariq, Mulder, Hillary, Coles, Adrian, Anstrom, Kevin J., Adams, Kirkwood F., Ezekowitz, Justin A., Fiuzat, Mona, Houston-Miller, Nancy, Mark, Daniel B., Piña, Ileana L., Passmore, Gayle, Whellan, David J., Cooper, Lawton S., Leifer, Eric S., Desvigne-Nickens, Patrice, Felker, G. Michael, O'Connor, Christopher M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 03.09.2019; Elsevier Limited
• Subjects: Aged; Biomarkers; Biomarkers - blood; Blood pressure; Brain natriuretic peptide; Cardiology; Cardiomyopathy; Cardiovascular; Chronic Disease; Congestive heart failure; Ejection fraction; Female; Heart failure; Heart Failure - blood; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Hospitalization; Humans; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; natriuretic peptides; outcomes; Peptide Fragments - blood; Peptides; Practice Guidelines as Topic; Prognosis; Quality of life; Stroke Volume; Treatment Outcome; heart failure; natriuretic peptides; ACE; CV; NT-proBNP; OR; outcomes; GDMT; KCCQ; CI; HR; HFrEF; amino-terminal pro–B-type natriuretic peptide; odds ratio; cardiovascular; guideline-directed medical therapy; Kansas City Cardiomyopathy Questionnaire; hazard ratio; confidence interval; heart failure with reduced ejection fraction; angiotensin-converting enzyme
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2019.06.055

The GUIDE-IT (GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial demonstrated that a strategy to “guide” application of guideline-directed medical therapy (GDMT) by reducing amino-terminal pro–B-type natriuretic peptide (NT-proBNP) was not superior to GDMT alone. The purpose of this study was to examine the prognostic meaning of NT-proBNP changes following heart failure (HF) therapy intensification relative to the goal NT-proBNP value of 1,000 pg/ml explored in the GUIDE-IT trial. A total of 638 study participants were included who were alive and had available NT-proBNP results 90 days after randomization. Rates of subsequent cardiovascular (CV) death/HF hospitalization or all-cause mortality during follow-up and Kansas City Cardiomyopathy Questionnaire (KCCQ) overall scores were analyzed. A total of 198 (31.0%) subjects had an NT-proBNP ≤1,000 pg/ml at 90 days with no difference in achievement of NT-proBNP goal between the biomarker-guided and usual care arms. NT-proBNP ≤1,000 pg/ml by 90 days was associated with longer freedom from CV/HF hospitalization or all-cause mortality (p < 0.001 for both) and lower adjusted hazard of subsequent HF hospitalization/CV death (hazard ratio: 0.26; 95% confidence interval: 0.15 to 0.46; p < 0.001) and all-cause mortality (hazard ratio: 0.34; 95% confidence interval: 0.15 to 0.77; p = 0.009). Regardless of elevated baseline concentration, an NT-proBNP ≤1,000 pg/ml at 90 days was associated with better outcomes and significantly better KCCQ overall scores (p = 0.02). Patients with heart failure with reduced ejection fraction whose NT-proBNP levels decreased to ≤1,000 pg/ml during GDMT had better outcomes. These findings may help to understand the results of the GUIDE-IT trial. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840) [Display omitted]