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The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial.

Publication ,  Journal Article
Ezekowitz, JA; Alemayehu, W; Rathwell, S; Grant, AD; Fiuzat, M; Whellan, DJ; Ahmad, T; Adams, K; Piña, IL; Cooper, LS; Januzzi, JL; Leifer, ES ...
Published in: ESC Heart Fail
February 2022

AIMS: N-terminal pro-b-type natriuretic peptide (NT-proBNP) values may be influenced by patient factors beyond the severity of illness, including atrial fibrillation (AF), renal dysfunction, or increased body mass index (BMI). We hypothesized that these factors may influence the achievement of NT-proBNP targets and clinical outcomes. METHODS: A total of 894 patients with heart failure with reduced ejection fraction were enrolled in The Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment trial. NT-proBNP was analysed every 3 months. RESULTS: Forty per cent of patients had AF, the median estimated glomerular filtration rate (eGFR) was 59 mL/min/1.73 m2 [interquartile range (IQR) 43-76], and median BMI was 29 kg/m2 (IQR 25-34). Patients with AF, eGFR < 60 mL/min/1.73 m2 , or a BMI < 29 kg/m2 had a higher level of NT-proBNP at randomization and over all study visits (all P values < 0.001). Over 18 months, the rate of change of NT-proBNP was less for patients with AF (compared with those without AF, P = 0.037) and patients with an eGFR < 60 mL/min/1.73 m2 (compared with eGFR > 60 mL/min/1.73 m2 , P < 0.001). The rate of change of NT-proBNP was similar for patients with a BMI above or below the median value. Using the 90 day NT-proBNP, patients with AF, lower eGFR, or lower BMI were less likely to achieve the target NT-proBNP < 1000 pg/mL than patients without AF, higher eGFR, or higher BMI, respectively. None of these differed between the Usual Care or Guided Care arm for AF, eGFR, or BMI (Pinteractions all NS). CONCLUSIONS: Patients with AF, a lower BMI, or worse renal function are less likely to achieve a lower or target NT-proBNP. Clinicians should be aware of these factors both when interpreting NT-proBNP levels and making therapeutic decisions about heart failure therapies.

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Published In

ESC Heart Fail

DOI

EISSN

2055-5822

Publication Date

February 2022

Volume

9

Issue

1

Start / End Page

77 / 86

Location

England

Related Subject Headings

  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Humans
  • Heart Failure
  • Atrial Fibrillation
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Ezekowitz, J. A., Alemayehu, W., Rathwell, S., Grant, A. D., Fiuzat, M., Whellan, D. J., … Felker, G. M. (2022). The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial. ESC Heart Fail, 9(1), 77–86. https://doi.org/10.1002/ehf2.13692
Ezekowitz, Justin A., Wendimagegn Alemayehu, Sarah Rathwell, Andrew D. Grant, Mona Fiuzat, David J. Whellan, Tariq Ahmad, et al. “The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial.ESC Heart Fail 9, no. 1 (February 2022): 77–86. https://doi.org/10.1002/ehf2.13692.
Ezekowitz JA, Alemayehu W, Rathwell S, Grant AD, Fiuzat M, Whellan DJ, et al. The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial. ESC Heart Fail. 2022 Feb;9(1):77–86.
Ezekowitz, Justin A., et al. “The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial.ESC Heart Fail, vol. 9, no. 1, Feb. 2022, pp. 77–86. Pubmed, doi:10.1002/ehf2.13692.
Ezekowitz JA, Alemayehu W, Rathwell S, Grant AD, Fiuzat M, Whellan DJ, Ahmad T, Adams K, Piña IL, Cooper LS, Januzzi JL, Leifer ES, Mark D, O’Connor CM, Felker GM. The influence of comorbidities on achieving an N-terminal pro-b-type natriuretic peptide target: a secondary analysis of the GUIDE-IT trial. ESC Heart Fail. 2022 Feb;9(1):77–86.
Journal cover image

Published In

ESC Heart Fail

DOI

EISSN

2055-5822

Publication Date

February 2022

Volume

9

Issue

1

Start / End Page

77 / 86

Location

England

Related Subject Headings

  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Humans
  • Heart Failure
  • Atrial Fibrillation
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology