Prognostic Implications of Changes in Amino-Terminal Pro–B-Type Natriuretic Peptide in Acute Decompensated Heart Failure: Insights From ASCEND-HF

Justin L Grodin, MAX J. LIEBO, JAVED BUTLER, MARCO METRA, G. MICHAEL FELKER, ADRIAN F. HERNANDEZ, ADRIAAN A. VOORS, JOHN J. MCMURRAY, PAUL W. ARMSTRONG, CHRISTOPHER O'CONNOR, RANDALL C. STARLING, RICHARD W. TROUGHTON, W. H.WILSON TANG

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Amino-terminal pro–B-type natriuretic peptide (NTproBNP)is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification. Methods: Baseline, 48–72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF. Results: The median NTproBNP at baseline was 5773 (2981–11,579)pg/mL; at 48–72 hours was 3036 (1191–6479)pg/mL; and at 30 days was 2914 (1364–6667)pg/mL. Absolute changes in NTproBNP by 48–72 hours were not associated with 30-day heart failure rehospitalization or mortality (P =.065), relative changes in NTproBNP were nominally associated (P =.046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48–72 hours and to 30 days were closely associated with 180-day mortality (P <.02 for all)with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points). Conclusions: Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StatePublished - Jan 1 2019

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Natriuretic Peptides
Heart Failure
pro-brain natriuretic peptide (1-76)
Mortality
Proportional Hazards Models

Keywords

  • acute heart failure
  • Natriuretic peptide
  • nesiritide

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic Implications of Changes in Amino-Terminal Pro–B-Type Natriuretic Peptide in Acute Decompensated Heart Failure : Insights From ASCEND-HF. / Grodin, Justin L; LIEBO, MAX J.; BUTLER, JAVED; METRA, MARCO; FELKER, G. MICHAEL; HERNANDEZ, ADRIAN F.; VOORS, ADRIAAN A.; MCMURRAY, JOHN J.; ARMSTRONG, PAUL W.; O'CONNOR, CHRISTOPHER; STARLING, RANDALL C.; TROUGHTON, RICHARD W.; TANG, W. H.WILSON.

In: Journal of Cardiac Failure, 01.01.2019.

Research output: Contribution to journalArticle

Grodin, JL, LIEBO, MAXJ, BUTLER, JAVED, METRA, MARCO, FELKER, GMICHAEL, HERNANDEZ, ADRIANF, VOORS, ADRIAANA, MCMURRAY, JOHNJ, ARMSTRONG, PAULW, O'CONNOR, CHRISTOPHER, STARLING, RANDALLC, TROUGHTON, RICHARDW & TANG, WHWILSON 2019, 'Prognostic Implications of Changes in Amino-Terminal Pro–B-Type Natriuretic Peptide in Acute Decompensated Heart Failure: Insights From ASCEND-HF', Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2019.04.002
Grodin, Justin L ; LIEBO, MAX J. ; BUTLER, JAVED ; METRA, MARCO ; FELKER, G. MICHAEL ; HERNANDEZ, ADRIAN F. ; VOORS, ADRIAAN A. ; MCMURRAY, JOHN J. ; ARMSTRONG, PAUL W. ; O'CONNOR, CHRISTOPHER ; STARLING, RANDALL C. ; TROUGHTON, RICHARD W. ; TANG, W. H.WILSON. / Prognostic Implications of Changes in Amino-Terminal Pro–B-Type Natriuretic Peptide in Acute Decompensated Heart Failure : Insights From ASCEND-HF. In: Journal of Cardiac Failure. 2019.
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abstract = "Background: Amino-terminal pro–B-type natriuretic peptide (NTproBNP)is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification. Methods: Baseline, 48–72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF. Results: The median NTproBNP at baseline was 5773 (2981–11,579)pg/mL; at 48–72 hours was 3036 (1191–6479)pg/mL; and at 30 days was 2914 (1364–6667)pg/mL. Absolute changes in NTproBNP by 48–72 hours were not associated with 30-day heart failure rehospitalization or mortality (P =.065), relative changes in NTproBNP were nominally associated (P =.046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48–72 hours and to 30 days were closely associated with 180-day mortality (P <.02 for all)with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points). Conclusions: Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.",
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T1 - Prognostic Implications of Changes in Amino-Terminal Pro–B-Type Natriuretic Peptide in Acute Decompensated Heart Failure

T2 - Insights From ASCEND-HF

AU - Grodin, Justin L

AU - LIEBO, MAX J.

AU - BUTLER, JAVED

AU - METRA, MARCO

AU - FELKER, G. MICHAEL

AU - HERNANDEZ, ADRIAN F.

AU - VOORS, ADRIAAN A.

AU - MCMURRAY, JOHN J.

AU - ARMSTRONG, PAUL W.

AU - O'CONNOR, CHRISTOPHER

AU - STARLING, RANDALL C.

AU - TROUGHTON, RICHARD W.

AU - TANG, W. H.WILSON

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N2 - Background: Amino-terminal pro–B-type natriuretic peptide (NTproBNP)is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification. Methods: Baseline, 48–72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF. Results: The median NTproBNP at baseline was 5773 (2981–11,579)pg/mL; at 48–72 hours was 3036 (1191–6479)pg/mL; and at 30 days was 2914 (1364–6667)pg/mL. Absolute changes in NTproBNP by 48–72 hours were not associated with 30-day heart failure rehospitalization or mortality (P =.065), relative changes in NTproBNP were nominally associated (P =.046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48–72 hours and to 30 days were closely associated with 180-day mortality (P <.02 for all)with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points). Conclusions: Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.

AB - Background: Amino-terminal pro–B-type natriuretic peptide (NTproBNP)is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification. Methods: Baseline, 48–72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF. Results: The median NTproBNP at baseline was 5773 (2981–11,579)pg/mL; at 48–72 hours was 3036 (1191–6479)pg/mL; and at 30 days was 2914 (1364–6667)pg/mL. Absolute changes in NTproBNP by 48–72 hours were not associated with 30-day heart failure rehospitalization or mortality (P =.065), relative changes in NTproBNP were nominally associated (P =.046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48–72 hours and to 30 days were closely associated with 180-day mortality (P <.02 for all)with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points). Conclusions: Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.

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KW - Natriuretic peptide

KW - nesiritide

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