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Utilizing NT-proBNP for Eligibility and Enrichment in Trials in HFpEF, HFmrEF, and HFrEF
Karolinska Inst, Dept Med, Div Cardiol, Stockholm, Sweden..
Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden..
Karolinska Inst, Dept Med, Div Cardiol, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
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2018 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 6, no 3, p. 246-256Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

The 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.

BACKGROUND

Optimizing 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.

METHODS

In 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.

RESULTS

In 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.

CONCLUSIONS

In 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.

Place, publisher, year, edition, pages
2018. Vol. 6, no 3, p. 246-256
Keywords [en]
eligibility, heart failure, N-terminal pro-B-type natriuretic peptide, registry, trials
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-351266DOI: 10.1016/j.jchf.2017.12.014ISI: 000426507700011PubMedID: 29428439OAI: oai:DiVA.org:uu-351266DiVA, id: diva2:1216345
Funder
Swedish Research Council, 2013-23897-104604-23Swedish Research Council, 523-2014-2336AstraZenecaSwedish Research CouncilAvailable from: 2018-06-11 Created: 2018-06-11 Last updated: 2018-06-11Bibliographically approved

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