Page 60 - Biomarkers for risk stratification and guidance in heart failure

Management of chronic heart failure guided by individual NT-proBNP targets.
Table 5. Number of increases in HF medication during follow-up.
NT-proBNP- Clinically- P-value Guided (n=174) Guided (n=171)
168 120 0.02 105 95 0.35 77 55 0.1 41 22 0.39 19 15 0.86 14 19 0.63 424 326 0.006
ACEI=angiotensin-converting enzyme inhibitor; ARB=angiotensin II receptor blocker; MRA=mineralocorticoid 3 receptor antagonist.
Diuretics Beta-blockers ACE-I
ARB
MRA Digoxin Total
Table 6. Changes in NT-proBNP, urea and creatinine levels during follow-up
6-Month 12-Month
Parameter
NT-proBNP, pg/ml
Urea, mmol/l Creatinine,
μmol/l
NT-proBNP- guided
-254
(-1,415 to 530)
-0.5
(-3.8 to 2.6)
7.00
(-12.0 to 32.0)
Clinically- P-value Guided
-287 0.60 (-1,186 to 688)
-0.8 0.41 (-3.3 to 1.2)
2.0 0.06 (-15 to 19)
NT-proBNP- guided
-432
(1,392 to 297)
0.0
(-3.8 to 2.2)
8.0
(-10.3 to 31.8)
Clinically- P-value Guided
-572 0.99 (-1,329 to 434)
-1.0 0.16 (-4.1 to 1.7)
3.0 0.07 (-14.0 to 22.0)
Values are expressed as median (interquartile range). NT-proBNP=N-terminal pro–B-type natriuretic peptide.
Table 7. Time-dependent HR if the outpatient NT-proBNP level is above the individually set target value
Outcome
Total mortality
CV mortality
HF mortality
First CV admission First HF admission
N (%)
103(29.9) 70(20.3) 45(13.0) 193(55.9) 115(33.3)
HR 95% CI
1.84 1.18–2.85 2.53 1.52–4.21 3.69 2.02–6.72 2.70 1.96–3.73 4.17 2.84–6.13
P-value
0.007 <0.001 <0.001 <0.001 <0.001
CI=confidence interval; CV=cardiovascular; HF=heart failure; HR=hazard ratio; NT-proBNP=N-terminal pro–B-type natriuretic peptide.
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