N-terminal pro brain natriuretic peptide-guided management in patients with heart failure and preserved ejection fraction: findings from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF)

Micha T. Maeder*, Peter Rickenbacher, Hans Rickli, Heidi Abbuehl, Marc Gutmann, Paul Erne, Andre Vuilliomenet, Martin Peter, Matthias Pfisterer, Hans-Peter Brunner-La Rocca

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

44 Citations (Web of Science)

Abstract

To assess the effects of an NT-proBNP-guided medical management on 18-month outcomes in patients with heart failure (HF) and preserved LVEF ( HFpEF). Patients with HFpEF (LVEF 45; n 123) and HF with reduced LVEF (HFrEF; LVEF 45; n 499) with age 60 years, NYHA class II, and elevated NT-proBNP (400 ng/L or 800 ng/L depending on age) were randomized to medical therapy titrated only to reduce symptoms to NYHA II (symptom-guided) or also to reduce NT-proBNP below the inclusion threshold (NT-proBNP-guided) during a 6-month period. Patients were followed for an additional 12 months. Despite similar treatment escalation, NT-proBNP reduction and symptom relief were less in HFpEF than in HFrEF. Hospitalization-free survival at 18 months was worse in HFpEF than in HFrEF (P 0.02), while survival and HF hospitalization-free survival did not differ. Among HFpEF patients, NT-proBNP reduction and symptom relief were similar in the symptom-guided (n 59) and NT-proBNP-guided (n 64) group despite more aggressive treatment in the NT-proBNP-guided group. In contrast to effects in HFrEF, NT-proBNP-guided management tended to worsen 18-month outcomes in HFpEF, with P-values for the interactions between LVEF stratum and management strategy of 0.2 for hospitalization-free survival, 0.03 for survival, and 0.01 for HF hospitalization-free survival. Outcomes in HFpEF were not better than in HFrEF, and opposite effects of NT-proBNP-guided management were observed in HFpEF compared with HFrEF. These preliminary findings suggest that, in contrast to HFrEF, NT-proBNP-guided therapy may not be beneficial in HFpEF.
Original languageEnglish
Pages (from-to)1148-1156
JournalEuropean journal of heart failure
Volume15
Issue number10
DOIs
Publication statusPublished - Oct 2013

Keywords

  • Heart failure
  • Preserved ejection fraction
  • Biomarker
  • Natriuretic peptide

Cite this