# Natriuretisch peptiderespons en uitkomsten bij chronisch HFrEF

*geplaatst 2019-09-03 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2019.06.055 · https://hartvaat.nl/2019/09/03/natriuretisch-peptiderespons-en-uitkomsten-bij-chronisch-hfref/*

Analyse naar de klinische betekenis van natriuretisch peptiderespons op behandeling bij chronisch hartfalen met verminderde ejectiefractie.

## English: Natriuretic Peptide Response and Outcomes in Chronic Heart Failure With Reduced Ejection Fraction.

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.

## Abstract (original, from the publication)

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).

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2019.06.055. Bijgewerkt 2026-07-03T18:38:44Z. 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.