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

• Published in: Journal of the American College of Cardiology Vol. 58; no. 18; pp. 1881 - 1889
• Main Authors: Januzzi, James L., Rehman, Shafiq U., Mohammed, Asim A., Bhardwaj, Anju, Barajas, Linda, Barajas, Justine, Kim, Han-Na, Baggish, Aaron L., Weiner, Rory B., Chen-Tournoux, Annabel, Marshall, Jane E., Moore, Stephanie A., Carlson, William D., Lewis, Gregory D., Shin, Jordan, Sullivan, Dorothy, Parks, Kimberly, Wang, Thomas J., Gregory, Shawn A., Uthamalingam, Shanmugam, Semigran, Marc J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 25.10.2011; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Aged; Ambulatory Care; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Chronic Disease; Diuretics; Drug dosages; Drug therapy; Female; Heart; Heart attacks; Heart failure; Heart Failure - blood; Heart Failure - diagnostic imaging; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization; Humans; Internal Medicine; Ischemia; Kaplan-Meier Estimate; Medical sciences; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; natriuretic peptides; outcomes; Peptide Fragments - blood; Peptides; Prospective Studies; Quality of Life; Standard of Care; Treatment Outcome; Ultrasonography; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - therapy; heart failure; natriuretic peptides; NT-proBNP; outcomes; GEE; SOC; LVSD; LV; HFpEF; HF; QOL; amino-terminal pro–B-type natriuretic peptide; generalized estimating equations; standard of care; left ventricular systolic dysfunction; heart failure with preserved ejection fraction; left ventricular; quality of life; Human; Guide; Peptides; Use; Cardiovascular disease; Patient; Heart ventricle; Left ventricular failure; Terminal; Chronic; Type; Treatment; Heart disease; Ambulatory; Circulatory system; Cardiology; Left ventricle performance
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2011.03.072

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