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Utilizing NT-proBNP...
Utilizing NT-proBNP for Eligibility and Enrichment in Trials in HFpEF, HFmrEF, and HFrEF
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- Savarese, Gianluigi (author)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Orsini, Nicola (author)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Hage, Camilla (author)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Vedin, Ola (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala Univ, Sweden; Uppsala Clin Res Ctr, Sweden
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- Cosentino, Francesco (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Rosano, Giuseppe M. C. (author)
- St Georges Univ, Cardiovasc & Cell Sci Res Inst, London, England.;Ist Ricovero & Cura Carattere Sci IRCCS San Raffa, Rome, Italy.
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- Dahlström, Ulf (author)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Lund, Lars H. (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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(creator_code:org_t)
- Elsevier BV, 2018
- 2018
- English.
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In: JACC. Heart failure. - : Elsevier BV. - 2213-1779 .- 2213-1787. ; 6:3, s. 246-256
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Abstract
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- OBJECTIVESThe purpose of this study was to assess the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiovascular (CV) versus non-CV events and between NT-proBNP and potential treatment effects in heart failure (HF) with preserved, mid-range, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF, respectively) and clinically relevant subgroups.BACKGROUNDOptimizing patient eligibility criteria in HF trials requires biomarkers that enrich for CV but not for non-CV events and select patients most likely to respond to the tested intervention.METHODSIn the Swedish HF registry population stratified by EF category, we used Kaplan-Meier curves to estimate unadjusted CV and non-CV risks (mortality or hospitalization); Poisson regressions to calculate crude event rates of CV and non-CV events according to NT-proBNP levels; and Cox regressions to calculate the adjusted hazard ratios for HF therapies according to NT-proBNP <= or > median.RESULTSIn a cohort of 15,849 patients (23% HFpEF, 21% HFmrEF, 56% HFrEF), median NT-proBNP was 2,037, 2,192, and 3,141 pg/ml, respectively. With increasing NT-proBNP, CV event rates increased more steeply than non-CV rates (range 20 to 160 and 30 to 100 per 100 patient-years in HFpEF; 20 to 130 and 20 to 100 in HFmrEF; and 20 to 110 and 20 to 50 in HFrEF, respectively). The CV-to-non-CV ratio increased with increasing NT-proBNP in HFpEF and HFrEF, but only in the lower range in HFmrEF. The association between treatments (e.g., angiotensin-converting enzyme-inhibitor, angiotensin II receptor blockers, and beta-blockers) and outcomes was consistent in NT-proBNP <= and > median.CONCLUSIONSIn HF trial design in different EF categories, NT-proBNP may be a useful tool for eligibility and enrichment for CV events, but its role in predicting a potential treatment response remains unclear.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- eligibility
- heart failure
- N-terminal pro-B-type natriuretic peptide
- registry
- trials
Publication and Content Type
- ref (subject category)
- art (subject category)
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