NT-proBNP Response and Prognosis in HFrEF With GDMT

Aug 26, 2019
Font Size
A
A
A
Authors:
Januzzi JL, Ahmad T, Mulder H, et al.
Citation:
Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol 2019;74:1205-1217.
Summary By:
Monica M. Colvin, MD

Study Questions:

Does achievement of N-terminal pro–B-type natriuretic peptide (NT-proBNP) to ≤1000 pg/ml at 90 days with guideline-directed medical therapy (GDMT) predict outcomes?

Methods:

An analysis of the GUIDE-IT (GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial was performed. Study participants who were alive at 90 days and who had NT-proBNP results available were included (n = 638). Heart failure (HF) hospitalization/cardiovascular (CV) death, all-cause mortality, and Kansas City Cardiomyopathy Questionnaire (KCCQ) overall scores were analyzed.

Results:

Approximately 31% of participants had achieved NT-proBNP ≤1000 pg/ml by 90 days (responders). Compared to nonresponders, responders were younger, more often female, and less symptomatic. In addition, they had a greater prevalence of nonischemic cardiomyopathy, lower baseline NT-proBNP levels, shorter duration of HF, and fewer co-morbid conditions. NT-proBNP ≤1000 pg/ml at 90 days was associated with longer freedom from HF hospitalization/CV death or all-cause mortality (p < 0.001 for both) and with reduced hazard for HF hospitalization/CV death (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.15-0.46; p < 0.001) and all-cause mortality (HR, 0.34; 95% CI, 0.15-0.77; p = 0.009). NT-proBNP ≤1000 pg/ml at 90 days was associated with favorable outcomes and quality-of-life (QOL) measures regardless of the baseline NT-proBNP, and conversely, those with NT-proBNP ≥1000 pg/ml at 90 days, regardless of baseline, had worse outcomes.

Conclusions:

Patients with HF and reduced ejection fraction (HFrEF) on GDMT who achieved NT-proBNP ≤1000 pg/ml at 90 days had significant reductions in hazard for HF hospitalization/CV death and for all-cause mortality. NT-proBNP ≤1000 pg/ml was also associated with significantly better QOL.

Perspective:

Achievement of NT-proBNP ≤1000 pg/ml with GDMT is associated with significantly better outcomes and QOL. Although using NT-proBNP to guide HF therapy did not improve outcomes, consideration could be given to NT-proBNP ≤1000 pg/ml as a measure of optimal management of HF, and failure to achieve NT-proBNP ≤1000 pg/ml with optimal GDMT could represent a trigger for more advanced therapies; however, more research is required to apply these findings.

Keywords: Biomarkers, Cardiomyopathies, Evidence-Based Practice, Heart Failure, Hospitalization, Natriuretic Peptide, Brain, Natriuretic Peptides, Outcome Assessment, Health Care, Peptide Fragments, Quality of Life, Stroke Volume


< Back to Listings