Key result
Higher baseline B-type natriuretic peptide (BNP) was strongly associated with increased long-term mortality (HR 2.09 per 1 SD increase) in heart failure patients treated with carvedilol.
Why the study?
Do baseline levels and on-treatment changes of serum biomarkers predict clinical outcomes and left ventricular improvement in heart failure patients treated de novo with carvedilol?
Cohort (n=86)
Open-label
No
Do baseline levels and on-treatment changes of serum biomarkers predict clinical outcomes and left ventricular improvement in heart failure patients treated de novo with carvedilol?
Hazard Ratio: 2.09 (95% CI 1.26–3.45)
p-value: p=0.004
In patients with heart failure starting carvedilol, different serum biomarkers predict distinct clinical outcomes: baseline BNP predicts long-term mortality, ET-1 predicts frequent hospitalizations, and CRP predicts left ventricular functional improvement.
Baseline BNP may aid mortality risk stratification in carvedilol-treated HF; leaves open whether biomarker-guided therapy improves outcomes.
BACKGROUND: The role of inflammatory and hemodynamic stress biomarkers in heart failure (HF) patients treated de novo with beta-blockers has been poorly studied. METHODS: A total of 86 patients (age 56 ± 9 years, 81 men) with left ventricular ejection fraction (LVEF) < 40% and previously not treated with beta-blockers were initiated on carvedilol. At baseline and 12 months later we performed echocardiography, cardiopulmonary exercise testing, and determined serum levels of B-type natriuretic peptide (BNP), endothelin-1 (ET-1), C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNF -a). Patients were followed up over a total period of 9 ± 3 years from baseline. RESULTS: Increased baseline CRP and its on-treatment decrease were associated with improvement of LVEF (est. coefficient per one SD: 1.6; 95% CI: -0.05,3.28; p = 0.056, and -1.80; -3.43, -0.18; p = 0.030, respectively) and diminishing of LV end-systolic volume index [mL/m2] (-6.83; -11.32; -2.34; p = 0.003, and 5.85; 1.23; -10.46; p = 0.014, respectively). Higher baseline ET-1 and on-treatment increase in TNF-a predicted frequent admissions (> 1) for cardiac complications (odds ratio per one SD: 1.98; 95% CI: 1.09-3.59; p = 0.025, and 2.07, 1.12-3.84, p = 0.021, respectively) whereas higher baseline BNP was associated with increased mortality (hazard ratio per one SD: 2.09, 95% CI: 1.26-3.45; p = 0.004). CONCLUSIONS: Serum biomarkers may have different roles in prediction of clinical outcomes among HF patients treated de novo with carvedilol.
No takes yet. Share an insight, caveat, or question.
Nessler et al. (2013) conducted a cohort in Chronic heart failure with reduced ejection fraction (n=86). Baseline B-type natriuretic peptide (BNP) vs. Lower baseline BNP was evaluated on Long-term all-cause mortality (HR 2.09, 95% CI 1.26-3.45, p=0.004). Higher baseline B-type natriuretic peptide (BNP) was strongly associated with increased long-term mortality (HR 2.09 per 1 SD increase) in heart failure patients treated with carvedilol.