NT-proBNP Goal Achievement Is Associated With Significant Reverse Remodeling and Improved Clinical Outcomes in HFrEF

被引:88
作者
Daubert, Melissa A. [1 ,2 ]
Adams, Kirkwood [3 ]
Yow, Eric [2 ]
Barnhart, Huiman X. [1 ,2 ]
Douglas, Pamela S. [1 ,2 ]
Rimmer, Susan [2 ]
Norris, Casey [2 ]
Cooper, Lawton [4 ]
Leifer, Eric [4 ]
Desvigne-Nickens, Patrice [4 ]
Anstrom, Kevin [1 ,2 ]
Fiuzat, Mona [1 ]
Ezekowitz, Justin [5 ]
Mark, Daniel B. [1 ,2 ]
O'Connor, Christopher M. [1 ,6 ]
Januzzi, James [7 ]
Felker, G. Michael [1 ,2 ]
机构
[1] Duke Univ, Med Ctr, Durham, NC 27705 USA
[2] Duke Clin Res Inst, 2400 Pratt St,Room 0311 Terrace Level, Durham, NC 27705 USA
[3] Univ N Carolina, Chapel Hill, NC 27515 USA
[4] NHLBI, Bldg 10, Bethesda, MD 20892 USA
[5] Univ Alberta, Edmonton, AB, Canada
[6] Inova Heart & Vasc Inst, Falls Church, VA USA
[7] Massachusetts Gen Hosp, Boston, MA 02114 USA
基金
美国国家卫生研究院;
关键词
biomarker-guided therapy; heart failure with reduced ejection fraction; reverse remodeling; NT-proBNP; CHRONIC HEART-FAILURE; BRAIN NATRIURETIC PEPTIDE; REDUCED EJECTION FRACTION; AMERICAN SOCIETY; EUROPEAN ASSOCIATION; PROGNOSTIC VALUE; TASK-FORCE; MORTALITY; THERAPY; ECHOCARDIOGRAPHY;
D O I
10.1016/j.jchf.2018.10.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study aims to assess the association between biomarker-guided therapy and left ventricular (LV) remodeling. BACKGROUND In patients with heart failure with reduced ejection fraction (HFrEF), it is unclear if lowering natriuretic peptides reflects structural and functional changes in the heart. This study aims to assess the association between biomarker-guided therapy and left ventricular (LV) remodeling. METHODS The GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) Echo Substudy was a multicenter study that randomized 268 patients with HFrEF (EF <= 40%) to either pro-B-type natriuretic peptide (NT-proBNP)-guided treatment or usual care. Echocardiograms were performed at baseline and 12 months in 124 patients. Remodeling indices and clinical outcomes were compared between treatment arms and by achievement of the NT-proBNP goal of <1,000 pg/ml at 12 months. RESULTS At 12 months, the changes in EF and LV volumes were similar between the biomarker-guided and usual care arms with no difference in clinical outcomes; however, lowering NT-proBNP to <1,000 pg/ml, regardless of treatment strategy, was associated with a significantly greater increase in EF compared with those not reaching goal (9.9 +/- 8.8% vs. 2.9 +/- 7.9%; p < 0.001) and lower LV volumes. The extent of reverse remodeling correlated with the change in NT-proBNP: a decrease of 1,000 pg/ml was associated with an increase in EF of 6.7% and a reduction in systolic and diastolic volumes of 17.3 ml/m(2) and 15.7 ml/m(2), respectively. Adverse events were significantly lower among patients achieving the NT-proBNP goal (p < 0.001). CONCLUSIONS Among patients with HFrEF, lowering NT-proBNP to <1,000 pg/ml by 12 months was associated with significant reverse remodeling and improved outcomes. A greater reduction in NT-proBNP was associated with more extensive reverse remodeling. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840) (C) 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
引用
收藏
页码:158 / 168
页数:11
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