Use of amino-terminal ProB-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction

James L. Januzzi, Shafiq U. Rehman, Asim A. Mohammed, Anju Bhardwaj, Linda Barajas, Justine Barajas, Han Na Kim, Aaron L. Baggish, Rory B. Weiner, Annabel Chen-Tournoux, Jane E. Marshall, Stephanie A. Moore, William D. Carlson, Gregory D. Lewis, Jordan Shin, Dorothy Sullivan, Kimberly Parks, Thomas J. Wang, Shawn A. Gregory, Shanmugam UthamalingamMarc J. Semigran

Research output: Contribution to journalArticle

259 Scopus citations

Abstract

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)

Original languageEnglish (US)
Pages (from-to)1881-1889
Number of pages9
JournalJournal of the American College of Cardiology
Volume58
Issue number18
DOIs
StatePublished - Oct 25 2011
Externally publishedYes

Keywords

  • heart failure
  • natriuretic peptides
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Januzzi, J. L., Rehman, S. U., Mohammed, A. A., Bhardwaj, A., Barajas, L., Barajas, J., Kim, H. N., Baggish, A. L., Weiner, R. B., Chen-Tournoux, A., Marshall, J. E., Moore, S. A., Carlson, W. D., Lewis, G. D., Shin, J., Sullivan, D., Parks, K., Wang, T. J., Gregory, S. A., ... Semigran, M. J. (2011). Use of amino-terminal ProB-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. Journal of the American College of Cardiology, 58(18), 1881-1889. https://doi.org/10.1016/j.jacc.2011.03.072