Prognostic Impact of Sustained Reduction of N-Terminal Pro-B-Type Natriuretic Peptide After Initiating Sacubitril/Valsartan　― Insights From the REVIEW-HF Registry

• Published in: Circulation Reports Vol. 7; no. 6; pp. 433 - 441
• Main Authors: Takigami, Yu, Ishii, Shunsuke, Iida, Yuichiro, Ikeda, Yuki, Nabeta, Takeru, Oikawa, Jun, Nasu, Takahito, Kanaoka, Koshiro, Kagiyama, Nobuyuki, Kida, Keisuke, Fujimoto, Wataru, Kikuchi, Atsushi, Ijichi, Takeshi, Shibata, Tatsuhiro, Ako, Junya, Matsumoto, Shingo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 10.06.2025
• Subjects: Heart Failure; N-terminal pro-B-type natriuretic peptide; Original; Repeated monitoring; Risk management; Sacubitril/valsartan; Heart failure; Sacubitril/valsartan; N-terminal pro-B-type natriuretic peptide; Repeated monitoring; Risk management
• ISSN: 2434-0790; 2434-0790
• DOI: 10.1253/circrep.CR-25-0029

Background: Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) values after initiating sacubitril/valsartan (Sac/Val) are considered a favorable prognostic factor in patients with heart failure (HF). However the relationship between the trajectory of repeated NT-proBNP measurements and cardiovascular events after Sac/Val remains uncertain.Methods and Results: A Japanese nationwide multicenter study enrolled 995 patients who were prescribed Sac/Val from August 2020 to August 2021. Of them, 434 patients who had a complete set of NT-proBNP measurements were divided into 3 groups: sustained-responder group (n=129), with ≥10% reduction in NT-proBNP at 1 month and further ≥10% reduction at 3 months; transient-responder group (n=161), with ≥10% reduction at 1 month but not at 3 months; and non-responder group (n=144), without ≥10% reduction at 1 month. There were no significant differences in the mean Sac/Val dose at each measurement point among the 3 groups. During a median follow-up of 456 (interquartile range: 371–549) days, the primary endpoint, which was either cardiovascular death or hospitalization for HF, occurred in 78 patients. Kaplan-Meier analysis revealed that the sustained-responder group had a significantly higher event-free survival rate among the 3 groups (Log-rank P<0.001).Conclusions: Repeated NT-proBNP monitoring and the pattern of the NT-proBNP trajectory after Sac/Val may be helpful in optimizing HF therapy and understanding the prognosis of HF.