What is the clinical evidence from this study?

Study design: RCT. Population: Heart failure with preserved left ventricular ejection fraction (HFPEF) (n=375). Intervention: Highest quartile of NT-proBNP (>1035 pg/mL) vs. Lowest quartile of NT-proBNP (<176 pg/mL). Primary outcome: All-cause mortality or heart failure-related hospitalization (HR 4.47, 95% CI 2.30-8.72).

April 14, 2012Open Access

Relationship between Plasma Concentrations of N-Terminal Pro Brain Natriuretic Peptide and the Characteristics and Outcome of Patients with a Clinical Diagnosis of Diastolic Heart Failure: A Report from the PEP-CHF Study

Q: What are the key findings of this study?

Patients in the highest quartile of NT-proBNP had a significantly increased risk of all-cause mortality or heart failure-related hospitalization compared to the lowest quartile (HR 4.47; 95% CI 2.30-8.72).

Key Result

Patients in the highest quartile of NT-proBNP had a significantly increased risk of all-cause mortality or heart failure-related hospitalization compared to the lowest quartile (HR 4.47; 95% CI 2.30-8.72).

Study Design

Type

RCT (n=375)

Randomization

Randomized

Structured PICO

Is plasma NT-proBNP concentration associated with the risk of all-cause mortality or heart failure-related hospitalization in patients with heart failure and preserved LVEF?

Population

375 patients with symptoms and signs of heart failure, LVEF >40%, and evidence of LV diastolic dysfunction.

Intervention

NT-proBNP measurement (highest quartile >1035 pg/mL)

Comparator

Lowest quartile of NT-proBNP (<176 pg/mL)

Outcome

Composite of all-cause mortality or heart failure-related hospitalizationcomposite

Higher plasma concentrations of NT-proBNP are strongly associated with an increased risk of all-cause mortality or heart failure hospitalization in patients with HFpEF.

Main Result

Hazard Ratio: 4.47 (95% CI 2.3–8.72)

Abstract

AIM: The aim of this study was to explore the relationships between plasma concentrations of N-terminal pro brain natriuretic peptide (NT-proBNP) and characteristics and prognosis of patients with heart failure and preserved (HFPEF) left ventricular ejection fraction (LVEF). No substantial trial has shown that treatment alters prognosis in patients with HFPEF due, in part, to much lower than anticipated event rates. The lack of a simple, objective test to identify patients with HFPEF at increased risk of cardiovascular events would be valuable. METHODS AND RESULTS: The Perindopril in Elderly People with Chronic Heart Failure Trial (PEP-CHF) was a randomized, controlled trial comparing perindopril and placebo in patients with symptoms and signs of heart failure who had an LVEF >40% and evidence of LV diastolic dysfunction. The primary endpoint was all-cause mortality or heart failure-related hospitalization. NT-proBNP was measured in 375 patients. Quartile thresholds were 176, 409, and 1035 pg/mL. Patients in the highest quartile of NT-proBNP were older, had lower body mass, more often had atrial fibrillation, had greater atrial and ventricular dimensions and a lower LVEF, and were more likely to receive loop diuretic therapy. Compared with the first quartile of NT-proBNP, the hazard ratios for the primary endpoint in the second 1. 38 95% confidence interval (CI) 0. 64-2. 99, third 2. 84 (95% CI 1. 42-5. 72), and fourth 4. 47 (95% CI 2. 30-8. 72) quartiles were increased. In a multivariable model, NT-proBNP, but not echocardiographic measures, was associated with outcome. CONCLUSIONS: NT-proBNP is a powerful prognostic marker in patients with HFPEF.