Relationship of Baseline NT-proBNP to Responsiveness to Vagus Nerve Stimulation in Patients with Heart Failure and Reduced Ejection Fraction

Abstract

Background Recent studies of patients with HFrEF have suggested that lower baseline NT-proBNP levels are associated with improved morbidity/mortality outcomes with pharmaceutical treatment. Neuromodulation (NM) using carotid nerve plexus stimulation has also been associated with better clinical outcomes when baseline NT-proBNP Objective We evaluated the relationship of baseline NT-proBNP to changes in symptoms and function in patients during NM using VNS for 6 months in ANTHEM-HF. Methods NT-proBNP was collected for exploratory analysis and not used as an inclusion criterion for the study. A repeated measures, generalized-estimating, equations model evaluated the relationship of baseline NT-proBNP values above and below 1,600 pg/ml to symptomatic and functional responses. Results The median (interquartile range; maximum) NT-proBNP was 868 (322, 1875; 14,656) pg/ml (n=58). Heart rate (HR), HR variability (SDNN), 6-minute walk distance, MLWHF mean score, and NYHA improved significantly at 6 months, independent of baseline NT-proBNP. While there was a statistical interaction observed between lower baseline NT-proBNP and better LVEF improvement, LVEF improved clinically in the overall cohort (32±7 to 37±10% [p=0.0042]), and in the two subgroups with NT-proBNP below or above the median for the study population (36±6 to 42±10% [n=29; p Conclusions In ANTHEM-HF, overall symptomatic and functional response to ART was not associated with baseline NT-proBNP. These findings are preliminary and hypothesis-generating. The ongoing ANTHEM-HFrEF Pivotal Study (NCT03425422) is likely to provide additional insight.