Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction.
OBJECTIVE
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).
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jjanuzzi@partners.org
James L
JL
Januzzi
Shafiq U
SU
Rehman
Asim A
AA
Mohammed
Anju
A
Bhardwaj
Linda
L
Barajas
Justine
J
Barajas
Han-Na
HN
Kim
Aaron L
AL
Baggish
Rory B
RB
Weiner
Annabel
A
Chen-Tournoux
Jane E
JE
Marshall
Stephanie A
SA
Moore
William D
WD
Carlson
Gregory D
GD
Lewis
Jordan
J
Shin
Dorothy
D
Sullivan
Kimberly
K
Parks
Thomas J
TJ
Wang
Shawn A
SA
Gregory
Shanmugam
S
Uthamalingam
Marc J
MJ
Semigran
D000368:Aged; D000553:Ambulatory Care; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011788:Quality of Life; D059039:Standard of Care; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000628:therapy*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain