Clinical Implication of N-Terminal Pro-Brain Natriuretic Peptide Burden in Heart Failure With Reduced Ejection Fraction: From the GUIDE-IT

Abstract

AimsThe aim of the study was to explore the prognostic implication of N-terminal pro-brain natriuretic peptide (NT-proBNP) burden on heart failure with reduced ejection fraction (HFrEF). MethodsWe performed a post-hoc analysis of the GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) trial. NT-proBNP burden was defined as the proportion of days with elevated NT-proBNP (≥1800 pg/ml) to the whole observation time. Cox proportional hazards regression model was used to evaluate the association with NT-proBNP burden and prognosis. ResultsA total of 815 patients with HFrEF were analyzed in our study. Patients were categorized into 4 groups according to the degree of NT-proBNP burden. In the multivariate cox analysis, NT-proBNP burden was significantly associated with all-cause mortality, cardiovascular (CV) mortality and HF hospitalization. Compared to patients without NT-proBNP burden, the risk for composite outcome increased by 210% (HR 3.10, 95% CI 1.72-5.58, p<0.001) in NT-proBNP burden 1 (mild) group, 432% (HR 5.32, 95% CI 2.93-9.67, p<0.001) in NT-proBNP burden 2 (moderate) group and over 12 times (HR 13.15, 95% CI 7.42-23.33, p<0.001) in NT-proBNP burden 3 (severe) group. Sensitivity analyses stratified by age and renal function yielded similar results. ConclusionsHigher NT-proBNP burden was associated with significant increase in risks of all-cause mortality, CV mortality, HF hospitalization and composite outcome. The results suggested that NT-proBNP burden could be an important predictor of the prognosis of patients with HFrEF.