Prognostic Implications of Changes in N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Heart Failure

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:68

Article

Zile, Michael R.^1,2  Claggett, Brian L.³  Prescott, Margaret F.⁴  McMurray, John J. V.⁵  Packer, Milton⁶  Rouleau, Jean L.^7,8  Swedberg, Karl⁹  Desai, Akshay S.³  Gong, Jianjian⁴  Shi, Victor C.⁴  Solomon, Scott D.³ 

[1] Med Univ South Carolina, Charleston, SC USA

[2] Ralph H Johnson Vet Adm Med Ctr, Charleston, SC USA

[3] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[4] Novartis Pharmaceut, E Hanover, NJ USA

[5] Univ Glasgow, Glasgow, Lanark, Scotland

[6] Baylor Univ, Med Ctr, Dallas, TX USA

[7] Montreal Heart Inst, Montreal, PQ, Canada

[8] Univ Montreal, Montreal, PQ, Canada

[9] Univ Gothenburg, Gothenburg, Sweden

关键词: biomarker;    chronic heart failure;    natriuretic peptide;    reduced ejection fraction;   

DOI  :  10.1016/j.jacc.2016.09.931

来源: Elsevier

【 摘 要 】

BACKGROUND Natriuretic peptides (NP) have prognostic value in heart failure (HF), although the clinical importance of changes in NP from baseline is unclear. OBJECTIVES The authors assessed whether a reduction in N-terminal pro-B-type NP (NT-proBNP) was associated with a decrease in HF hospitalization and cardiovascular mortality (primary endpoint) in patients with HF and reduced ejection fraction, whether treatment with sacubitril/valsartan reduced NT-proBNP below specific partition values more than enalapril, and whether the relationship between changes in NT-proBNP and changes in the primary endpoint were dependent on assigned treatment. METHODS In PARADIGM-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial), baseline NT-proBNP was measured in 2,080 patients; 1,292 had baseline values >1,000 pg/ml and were reassessed at 1 and 8 months. We related change in NT-proBNP to outcomes. RESULTS One month after randomization, 24% of the baseline NT-proBNP levels >1,000 pg/ml had fallen to <= 1,000 pg/ml. Risk of the primary endpoint was 59% lower in patients with a fall in NT-proBNP to <= 1,000 pg/ml than in those without such a fall. In sacubitril/valsartan-treated patients, median NT-proBNP was significantly lower 1 month after randomization than in enalapril-treated patients, and it fell to <= 1,000 pg/ml in 31% versus 17% of patients treated with sacubitril/valsartan and enalapril, respectively. There was no significant interaction between treatment and the relationship between change in NT-proBNP and the subsequent risk of the primary endpoint. CONCLUSIONS Patients who attained a significant reduction in NT-proBNP had a lower subsequent rate of cardiovascular death or HF hospitalization independent of the treatment group. Treatment with sacubitril/valsartan was nearly twice as likely as enalapril to reduce NT-proBNP to values <= 1,000 pg/ml. (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) [PARADIGM-HF]; NCT01035255.) (C) 2016 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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