Differences in NT-proBNP Response and Prognosis in Men and Women With Heart Failure With Reduced Ejection Fraction.

Journal Article (Multicenter Study;Journal Article)

Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a prognostic biomarker in heart failure (HF) with reduced ejection fraction. However, it is unclear whether there is a sex difference in NT-proBNP response and whether the therapeutic goal of NT-proBNP ≤1000 pg/mL has equivalent prognostic value in men and women with HF with reduced ejection fraction. Methods and Results In a secondary analysis of the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial we analyzed trends in NT-proBNP and goal attainment by sex. Differences in clinical characteristics, HF treatment, and time to all-cause death or HF hospitalization were compared. Landmark analysis at 3 months determined the prognostic value of early NT-proBNP goal achievement in men and women. Of the 286 (32%) women and 608 (68%) men in the GUIDE-IT trial, women were more likely to have a nonischemic cause and shorter duration of HF. Guideline-directed medical therapy was less intense over time in women. The absolute NT-proBNP values were consistently lower in women; however, the change in NT-proBNP and clinical outcomes were similar. After adjustment, women achieving the NT-proBNP goal had an 82% reduction in death or HF hospitalization compared with a 59% reduction in men. Conclusions Men and women with HF with reduced ejection fraction had a similar NT-proBNP response despite less intensive HF treatment among women. However, compared with men, the early NT-proBNP goal of ≤1000 pg/mL had greater prognostic value in women. Future efforts should be aimed at intensifying guideline-directed medical therapy in women, which may result in greater NT-proBNP reductions and improved outcomes in women with HF with reduced ejection fraction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01685840.

Full Text

Duke Authors

Cited Authors

  • Daubert, MA; Yow, E; Barnhart, HX; Piña, IL; Ahmad, T; Leifer, E; Cooper, L; Desvigne-Nickens, P; Fiuzat, M; Adams, K; Ezekowitz, J; Whellan, DJ; Januzzi, JL; O'Connor, CM; Felker, GM

Published Date

  • May 1, 2021

Published In

Volume / Issue

  • 10 / 10

Start / End Page

  • e019712 -

PubMed ID

  • 33955231

Pubmed Central ID

  • PMC8200692

Electronic International Standard Serial Number (EISSN)

  • 2047-9980

International Standard Serial Number (ISSN)

  • 2047-9980

Digital Object Identifier (DOI)

  • 10.1161/jaha.120.019712


  • eng