Prognostic Impact of Repeated NT-proBNP for HFrEF

Dec 22, 2023
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Authors:
Fuery MA, Leifer ES, Samsky MD, et al.
Citation:
Prognostic Impact of Repeated NT-proBNP Measurements in Patients With Heart Failure With Reduced Ejection Fraction. JACC Heart Fail 2023;Dec 20:[Epublished].
Summary By:
Supriya Shore, MD

Quick Takes

  • Serial NT-proBNP levels in chronic, stable HF patients served as a better prognostic marker for CV death or HF hospitalization compared to a single NT-proBNP level.
  • Change in NT-proBNP level preceded either CV death or HF hospitalization by 200 days on an average.
  • Change in NT-proBNP levels should warrant consideration of change in HF therapy, likely even in the absence of symptoms.

Study Questions:

What is the prognostic impact of serial N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels in stable patients with chronic heart failure (HF)?

Methods:

This was a post hoc analysis of the GUIDE-IT trial, a randomized clinical trial of patients with HF with reduced ejection fraction (HFrEF) with NT-proBNP >2000 or BNP >400 or history of HF hospitalization. Patients were randomized to usual care versus NT-proBNP guided strategy. The trial was prematurely terminated for futility. For this study, follow-up NT-proBNP was compared to baseline NT-proBNP. Association between NT-proBNP change and cardiovascular (CV) death or HF hospitalization was examined.

Results:

A total of 894 patients were studied with 328 (37%) patients having an HF hospitalization or CV death. Repeated NT-proBNP measurements served as a better prognostic marker for CV death or HF hospitalization compared to baseline NT-proBNP alone. After adjustment of baseline characteristics, each doubling of baseline NT-proBNP was associated with a hazard ratio of 1.17 (95% confidence interval, 1.08-1.28) for CV death or HF hospitalization compared with use of a single baseline NT-proBNP level as a risk predictor. On an average, an increase in NT-proBNP level preceded CV death or HF hospitalization by 200 days.

Conclusions:

In a post hoc analysis of a randomized trial in 894 patients, repeated NT-proBNP levels were a better prognostic marker of CV death or HF hospitalization than a single NT-proBNP level.

Perspective:

NT-proBNP is a well-established prognostic marker for HF. Existing studies largely, however, establish prognostic relevance of a single NT-proBNP level. Therefore, frequency of repeated NT-proBNP levels is largely dependent on physician practice and preference. This study evaluated prognostic implications of repeated NT-proBNP levels. There are several important findings worth considering. First, every doubling of NT-proBNP increased risk for CV death or HF hospitalization by 17%. Second, on an average, increase in NT-proBNP preceded CV death or HF hospitalization by 200 days. Third, reclassification of patient risk by serial NT-proBNP levels was a better prognostic marker than a single baseline level.

Noteworthy strengths include this being a post hoc analysis of a randomized trial that evaluated efficacy of NT-proBNP guided therapy versus standard of care. However, this analysis remains observational. These observations together suggest that rising NT-proBNP, probably even in the absence of new/worsening symptoms, should warrant changes in management for a stable, chronic HF patient.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Heart Failure, Natriuretic Peptide, Brain


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