{"id":"49c1ba505cdf","type":"article","url":"https://hartvaat.nl/2019/09/03/natriuretisch-peptiderespons-en-uitkomsten-bij-chronisch-hfref/","title":"Natriuretisch peptiderespons en uitkomsten bij chronisch HFrEF","title_en":"Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","chronische-nierziekte","hfref","nt-probnp","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.06.055","source_url":"https://doi.org/10.1016/j.jacc.2019.06.055","authors":["James L Januzzi","Tariq Ahmad","Hillary Mulder","Adrian Coles","Kevin J Anstrom","Kirkwood F Adams","Justin A Ezekowitz","Mona Fiuzat","Nancy Houston-Miller","Daniel B Mark","Ileana L Piña","Gayle Passmore","David J Whellan","Lawton S Cooper","Eric S Leifer","Patrice Desvigne-Nickens","G Michael Felker","Christopher M O'Connor"],"significance":5,"published":"2019-09-03","source_date":"2019-09-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This GUIDE-IT analysis showed that natriuretic peptide response patterns during heart failure therapy provide prognostic information even when biomarker-guided titration does not improve overall trial outcomes.","created":"2026-07-03T10:28:08Z","updated":"2026-07-03T18:38:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de klinische betekenis van natriuretisch peptiderespons op behandeling bij chronisch hartfalen met verminderde ejectiefractie.","abstract_original":"BACKGROUND: The GUIDE-IT (GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial demonstrated that a strategy to \"guide\" application of guideline-directed medical therapy (GDMT) by reducing amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was not superior to GDMT alone. OBJECTIVES: The purpose of this study was to examine the prognostic meaning of NT-proBNP changes following heart failure (HF) therapy intensification relative to the goal NT-proBNP value of 1,000 pg/ml explored in the GUIDE-IT trial. METHODS: A total of 638 study participants were included who were alive and had available NT-proBNP results 90 days after randomization. Rates of subsequent cardiovascular (CV) death/HF hospitalization or all-cause mortality during follow-up and Kansas City Cardiomyopathy Questionnaire (KCCQ) overall scores were analyzed. RESULTS: A total of 198 (31.0%) subjects had an NT-proBNP ≤1,000 pg/ml at 90 days with no difference in achievement of NT-proBNP goal between the biomarker-guided and usual care arms. NT-proBNP ≤1,000 pg/ml by 90 days was associated with longer freedom from CV/HF hospitalization or all-cause mortality (p < 0.001 for both) and lower adjusted hazard of subsequent HF hospitalization/CV death (hazard ratio: 0.26; 95% confidence interval: 0.15 to 0.46; p < 0.001) and all-cause mortality (hazard ratio: 0.34; 95% confidence interval: 0.15 to 0.77; p = 0.009). Regardless of elevated baseline concentration, an NT-proBNP ≤1,000 pg/ml at 90 days was associated with better outcomes and significantly better KCCQ overall scores (p = 0.02). CONCLUSIONS: Patients with heart failure with reduced ejection fraction whose NT-proBNP levels decreased to ≤1,000 pg/ml during GDMT had better outcomes. These findings may help to understand the results of the GUIDE-IT trial. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840)."}