Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction.
Published
Journal Article
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).
Full Text
Duke Authors
Cited Authors
- Januzzi, JL; Rehman, SU; Mohammed, AA; Bhardwaj, A; Barajas, L; Barajas, J; Kim, H-N; Baggish, AL; Weiner, RB; Chen-Tournoux, A; Marshall, JE; Moore, SA; Carlson, WD; Lewis, GD; Shin, J; Sullivan, D; Parks, K; Wang, TJ; Gregory, SA; Uthamalingam, S; Semigran, MJ
Published Date
- October 25, 2011
Published In
Volume / Issue
- 58 / 18
Start / End Page
- 1881 - 1889
PubMed ID
- 22018299
Pubmed Central ID
- 22018299
Electronic International Standard Serial Number (EISSN)
- 1558-3597
Digital Object Identifier (DOI)
- 10.1016/j.jacc.2011.03.072
Language
- eng
Conference Location
- United States