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

Abstract

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.

• Authors: Stephen J Greene, Aldo P Maggioni, Gregg C Fonarow, Scott D Solomon, Michael Böhm, Albert Kandra, Margaret F Prescott, Bernard Reimund, Tsushung A Hua, Anastasia Lesogor, Faiez Zannad, Mihai Gheorghiade, ASTRONAUT Investigators and Coordinators
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 17 Issue 1 Pg. 98-108 (Jan 2015) ISSN: 1879-0844 [Electronic] England
• PMID: 25597870 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

Chemical References

• Amides
• Fumarates
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• aliskiren
• Renin

Topics

• Aged
• Amides (therapeutic use)
• Chronic Disease
• Cohort Studies
• Disease Progression
• Female
• Fumarates (therapeutic use)
• Heart Failure (blood, drug therapy, mortality)
• Hospitalization
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Prognosis
• Proportional Hazards Models
• Renin (antagonists & inhibitors)