Clinical Research
Biomarkers
Use of Amino-Terminal Pro–B-Type Natriuretic Peptide to Guide Outpatient Therapy of Patients With Chronic Left Ventricular Systolic Dysfunction

https://doi.org/10.1016/j.jacc.2011.03.072Get rights and content
Under an Elsevier user license
open archive

Objectives

The aim of this study was to evaluate whether chronic heart failure (HF) therapy guided by concentrations of amino-terminal pro–B-type natriuretic peptide (NT-proBNP) is superior to standard of care (SOC) management.

Background

It is unclear whether standard HF treatment plus a goal of reducing NT-proBNP concentrations improves outcomes compared with standard management alone.

Methods

In a prospective single-center trial, 151 subjects with HF due to left ventricular (LV) systolic dysfunction were randomized to receive either standard HF care plus a goal to reduce NT-proBNP concentrations ≤1,000 pg/ml or SOC management. The primary endpoint was total cardiovascular events between groups compared using generalized estimating equations. Secondary endpoints included effects of NT-proBNP–guided care on patient quality of life as well as cardiac structure and function, assessed with echocardiography.

Results

Through a mean follow-up period of 10 ± 3 months, a significant reduction in the primary endpoint of total cardiovascular events was seen in the NT-proBNP arm compared with SOC (58 events vs. 100 events, p = 0.009; logistic odds for events 0.44, p = 0.02); Kaplan-Meier curves demonstrated significant differences in time to first event, favoring NT-proBNP–guided care (p = 0.03). No age interaction was found, with elderly patients benefitting similarly from NT-proBNP–guided care as younger subjects. Compared with SOC, NT-proBNP–guided patients had greater improvements in quality of life, demonstrated greater relative improvements in LV ejection fraction, and had more significant improvements in both LV end-systolic and -diastolic volume indexes.

Conclusions

In patients with HF due to LV systolic dysfunction, NT-proBNP–guided therapy was superior to SOC, with reduced event rates, improved quality of life, and favorable effects on cardiac remodeling. (Use of NT-proBNP Testing to Guide Heart Failure Therapy in the Outpatient Setting; NCT00351390)

Key Words

heart failure
natriuretic peptides
outcomes

Abbreviations and Acronyms

GEE
generalized estimating equations
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
LV
left ventricular
LVSD
left ventricular systolic dysfunction
NT-proBNP
amino-terminal pro–B-type natriuretic peptide
QOL
quality of life
SOC
standard of care

Cited by (0)

This study was supported in part by Roche Diagnostics, Inc. Dr. Januzzi is supported in part by the Balson Cardiac Scholar Fund; has received research grants and consultancy fees from Roche Diagnostics, Inc., Siemens Diagnostics, and Critical Diagnostics; and has received speakers fees from Roche Diagnostics, Inc. and Siemens Diagnostics. Drs. Rehman, Mohammed, Bhardwaj, and Kim are supported by the Dennis and Marilyn Barry Cardiology Fellowship. Dr. Shin has served as a consultant to Acceleron Pharma. Dr. Wang has been a coinvestigator on studies that received assay support from Siemens Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.