title: Improvement in structural and functional echocardiographic parameters during chronic heart failure therapy guided by natriuretic peptides: mechanistic insights from the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study.
abstract: OBJECTIVE
  We sought to determine if heart failure (HF) care with a goal to lower N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations, compared with standard of care (SOC) management, is associated with improvement in echocardiographic parameters of cardiac structure and function.
  
  
  RESULTS
  Of 151 subjects with HF due to left ventricular systolic dysfunction (LVSD) prospectively randomized to NT-proBNP-guided vs. SOC HF care, 116 had serial echocardiographic data. Endpoints in this echocardiographic study included the relationship between change in NT-proBNP and LV reverse remodelling, as well as associations between biomarker-guided therapy and measures of diastolic function, right ventricular (RV) size and function, estimates of LV filling pressure and RV systolic pressure (RVSP), and the degree of mitral regurgitation (MR). After a mean of 10 months of study procedures, in adjusted analyses, final NT-proBNP concentrations predicted risk of remodelling [hazard ratio (HR) ↑LV end-diastolic volume index = 1.43, 95% confidence interval (CI) 1.10-1.86, P = 0.007; HR ↑LV end-systolic volume index = 1.54, 95% CI 1.10-1.91, P = 0.01; HR ↓LV ejection fraction (LVEF) = 1.53, 905% CI 1.12-1.89, P = 0.02]. In addition to greater improvement in LVEF and reductions in LV volume, compared with SOC, NT-proBNP-guided patients showed significant decreases in the ratio of early transmitral peak velocity to early diastolic peak annular velocity (E/E'), pulmonary vein peak S velocity, RV fractional area change, RVSP, and MR severity.
  
  
  CONCLUSIONS
  NT-proBNP concentrations may serve as a non-invasive indicator of the state of cardiac structure and function in HF due to LVSD. Multiple, prognostically meaningful echocardiographic variables improved more significantly in patients treated with NT-proBNP-guided care vs. SOC.
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Rory B
authors.initials: RB
authors.lastname: Weiner
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
authors.forename: Annabel
authors.initials: A
authors.lastname: Chen-Tournoux
authors.forename: Jane E
authors.initials: JE
authors.lastname: Marshall
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.forename: Anju
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Asim A
authors.initials: AA
authors.lastname: Mohammed
authors.forename: Shafiq U
authors.initials: SU
authors.lastname: Rehman
authors.forename: Linda
authors.initials: L
authors.lastname: Barajas
authors.forename: Justine
authors.initials: J
authors.lastname: Barajas
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Gregory
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects*; D010446:Peptide Fragments / Q000097:blood / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain