TY - JOUR
T1 - Use of amino-terminal ProB-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction
AU - Januzzi, James L.
AU - Rehman, Shafiq U.
AU - Mohammed, Asim A.
AU - Bhardwaj, Anju
AU - Barajas, Linda
AU - Barajas, Justine
AU - Kim, Han Na
AU - Baggish, Aaron L.
AU - Weiner, Rory B.
AU - Chen-Tournoux, Annabel
AU - Marshall, Jane E.
AU - Moore, Stephanie A.
AU - Carlson, William D.
AU - Lewis, Gregory D.
AU - Shin, Jordan
AU - Sullivan, Dorothy
AU - Parks, Kimberly
AU - Wang, Thomas J.
AU - Gregory, Shawn A.
AU - Uthamalingam, Shanmugam
AU - Semigran, Marc J.
PY - 2011/10/25
Y1 - 2011/10/25
N2 - Objectives: The aim of this study was to evaluate whether chronic heart failure (HF) therapy guided by concentrations of amino-terminal proB-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-proBNPguided 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-proBNPguided care (p = 0.03). No age interaction was found, with elderly patients benefitting similarly from NT-proBNPguided care as younger subjects. Compared with SOC, NT-proBNPguided 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-proBNPguided 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)
AB - Objectives: The aim of this study was to evaluate whether chronic heart failure (HF) therapy guided by concentrations of amino-terminal proB-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-proBNPguided 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-proBNPguided care (p = 0.03). No age interaction was found, with elderly patients benefitting similarly from NT-proBNPguided care as younger subjects. Compared with SOC, NT-proBNPguided 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-proBNPguided 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)
KW - heart failure
KW - natriuretic peptides
KW - outcomes
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U2 - 10.1016/j.jacc.2011.03.072
DO - 10.1016/j.jacc.2011.03.072
M3 - Article
C2 - 22018299
AN - SCOPUS:80055011831
SN - 0735-1097
VL - 58
SP - 1881
EP - 1889
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -