Clinical profile and prognostic significance of natriuretic peptide trajectory following hospitalization for worsening chronic heart failure: findings from the ASTRONAUT trial

Autor:	Michael Böhm, Bernard Reimund, Gregg C. Fonarow, Stephen J. Greene, Anastasia Lesogor, Margaret F. Prescott, Coordinators, Faiez Zannad, Tsushung A. Hua, Aldo P. Maggioni, Mihai Gheorghiade, Albert Kandra, Scott D. Solomon, Astronaut Investigators
Rok vydání:	2015
Předmět:	medicine.medical_specialty Ejection fraction business.industry medicine.drug_class Hazard ratio Atrial fibrillation 030204 cardiovascular system & hematology medicine.disease Confidence interval 3. Good health 03 medical and health sciences 0302 clinical medicine Heart failure Internal medicine Cohort Cardiology medicine Natriuretic peptide cardiovascular diseases 030212 general & internal medicine Cardiology and Cardiovascular Medicine Intensive care medicine business Prospective cohort study hormones hormone substitutes and hormone antagonists
Zdroj:	European Journal of Heart Failure. 17:98-108
ISSN:	1388-9842
DOI:	10.1002/ejhf.201
Popis:	Aims The purpose of this study was to determine the prognostic significance and associated clinical profile of early post-discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) trajectory among patients hospitalized for worsening chronic heart failure (HHF). Methods and results This post-hoc analysis of the Aliskiren Trial in Acute Heart Failure Outcomes (ASTRONAUT) included 1351 HHF patients with ejection fraction (EF) ≤40%, elevated B-type natriuretic peptide ≥400 pg/mL or NT-proBNP ≥1600 pg/mL at admission, and available NT-proBNP measurements (from a central core laboratory) at baseline (median 5 days after admission) and 1-month follow-up. The co-primary endpoints were all-cause mortality and cardiovascular mortality or HHF within 12 months. Median follow-up was 11.3 months. Patients with decreasing post-discharge NT-proBNP trajectory tended to be younger and have non-ischaemic HF aetiology. The presence of baseline atrial fibrillation was associated with high NT-proBNP at 1 month (i.e. above the median), regardless of the baseline value. After adjustment for patient characteristics and 1-month NT-proBNP level, every twofold increase in continuous NT-proBNP change from baseline to 1 month was predictive of increased cardiovascular mortality or HHF (hazard ratio 1.14; 95% confidence interval 1.02–1.26), but not all-cause mortality (hazard ratio 0.95; 95% confidence interval 0.81–1.11). Conclusion In this cohort of HHF patients with reduced EF, early post-discharge NT-proBNP trajectory was associated with a distinct clinical profile and carried independent prognostic value after adjustment for patient characteristics and absolute NT-proBNP level. Future prospective study of serial NT-proBNP measurement during the hospital and early post-discharge periods is warranted to validate these findings and evaluate post-discharge NT-proBNP trajectory as a therapeutic target.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::f4e03aa6528d802c85a44f8399581918 https://doi.org/10.1002/ejhf.201 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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