What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart failure with reduced ejection fraction (HFrEF) receiving primary prevention ICD therapy (n=5117). Intervention: Elevated NT-pro BNP levels vs. Lower NT-pro BNP levels. Primary outcome: All-cause mortality (HR 2.12, 95% CI 1.53 to 2.93, p=<0.001).

What question did this study set out to answer?

To evaluate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) for predicting appropriate ICD shock and all-cause mortality in patients with heart failure with reduced ejection fraction receiving primary prevention therapy.

March 1, 2023Open HeartOpen Access

Role of N-terminal pro-B type natriuretic peptide as a predictor of poor outcomes in patients with HFrEF receiving primary prevention implantable cardioverter-defibrillator therapy: a systematic review and dose–response meta-analysis

Q: What are the key findings of this study?

Elevated NT-pro BNP levels were associated with increased all-cause mortality (HR 2.12; 95% CI 1.53-2.93; p<0.001) and appropriate ICD shock in patients with HFrEF.

Q: What question did this study set out to answer?

To evaluate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) for predicting appropriate ICD shock and all-cause mortality in patients with heart failure with reduced ejection fraction receiving primary prevention therapy.

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Key result

Elevated NT-proBNP linked to ~112% higher all-cause mortality and appropriate ICD shock in HFrEF.

HR 2.12
95% CI 1.53 to 2.93
P<0.001
n=5,117

Why the study?

Does elevated NT-pro BNP increase the risk of all-cause mortality and appropriate ICD shock in patients with HFrEF receiving primary prevention ICD therapy?

Key Points

To evaluate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) for predicting appropriate ICD shock and all-cause mortality in patients with heart failure with reduced ejection fraction receiving primary prevention therapy.
Systematic literature search conducted across multiple databases up to June 9, 2022, registered under PROSPERO CRD42022339285.
Included 9 studies comprising a total of 5,117 participants with heart failure with reduced ejection fraction undergoing primary prevention implantable cardioverter-defibrillator therapy.
Elevated NT-proBNP levels were significantly associated with all-cause mortality (HR = 2.12, 95% CI: 1.53 to 2.93, p < 0.001) and appropriate ICD shock (HR = 1.71, 95% CI: 1.18 to 2.49, p < 0.001).
Dose–response modeling revealed non-linear increases in risk per 100 pg/mL increase in NT-proBNP of approximately 3% for all-cause mortality and 5% for ICD shock, with risk curves steepening beyond an inflection point of 3,000 pg/mL (p-non-linearity < 0.001).

Study Design

Type

Meta-Analysis (n=5,117)

Structured PICO

Does elevated NT-pro BNP increase the risk of all-cause mortality and appropriate ICD shock in patients with HFrEF receiving primary prevention ICD therapy?

Population

5,117 participants across 9 studies with HFrEF receiving primary prevention ICD therapy.

Exposure

High levels of N-terminal pro-B type natriuretic peptide (NT-pro BNP)

Comparator

Lower levels of NT-pro BNP

Outcome

All-cause mortality and appropriate ICD shockhard clinical

Main Result

Hazard Ratio: 2.12 (95% CI 1.53–2.93)

p-value: p=<0.001

Elevated NT-pro BNP levels demonstrate a positive concentration-dependent association with all-cause mortality and appropriate ICD shocks in HFrEF patients, with risk increasing steeply above 3000 pg/mL.

Discussion

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Implication

May refine risk stratification in HFrEF ICD recipients; extends observational data but leaves practice change open.

Cite This Study

Prameswari et al. (2023) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) receiving primary prevention ICD therapy (n=5,117). Elevated NT-pro BNP levels vs. Lower NT-pro BNP levels was evaluated on All-cause mortality (HR 2.12, 95% CI 1.53 to 2.93, p=<0.001). Elevated NT-pro BNP levels were associated with increased all-cause mortality (HR 2.12; 95% CI 1.53-2.93; p<0.001) and appropriate ICD shock in patients with HFrEF.

synapsesocial.com/papers/6aa2ebb9eb5cc5d2cba591c6 https://doi.org/10.1136/openhrt-2022-002225

Topics

HFrEF treatment Heart failure Cardiac device therapy

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Role of N-terminal pro-B type natriuretic peptide as a predictor of poor outcomes in patients with HFrEF receiving primary prevention implantable cardioverter-defibrillator therapy: a systematic review and dose–response meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Role of N-terminal pro-B type natriuretic peptide as a predictor of poor outcomes in patients with HFrEF receiving primary prevention implantable cardioverter-defibrillator therapy: a systematic review and dose–response meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider