Use of Amino-Terminal Pro-B-Type Natriuretic Peptide to Guide Outpatient Therapy of Patients With Chronic Left Ventricular Systolic Dysfunction

作者：Januzzi James L Jr^*; Rehman Shafiq U; Mohammed Asim A; Bhardwaj Anju; Barajas Linda; Barajas Justine; Kim Han Na; Baggish Aaron L; Weiner Rory B; Chen Tournoux Annabel; Marshall Jane E; Moore Stephanie A; Carlson William D; Lewis Gregory D; Shin Jordan; Sullivan Dorothy; Parks Kimberly; Wang Thomas J; Gregory Shawn A; Uthamalingam Shanmugam; Semigran Marc J

来源：Journal of the American College of Cardiology, 2011, 58(18): 1881-1889.

DOI：10.1016/j.jacc.2011.03.072

• heart failure
• natriuretic peptides
• outcomes

Objectives The aim of this study was to evaluate whether chronic heart failure (HF) therapy guided by concentrations of amino-terminal pro-B-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-proBNP-guided 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-proBNP-guided care (p = 0.03). No age interaction was found, with elderly patients bene-fitting similarly from NT-proBNP-guided care as younger subjects. Compared with SOC, NT-proBNP-guided 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-proBNP-guided therapy was superior to SOC, with reduced event rates, improved quality of life, and favorable effects on cardiac remodeling.

• 出版日期2011-10-25