2015


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2015/№4

Nt-proBNP-guided therapy reduces risk of death and hospitalization in patients after decompensation of heart failure

Skvortsov A. A., Koshkina D. E., Protasov V. N., Narusov O. Yu., Masenko V. P., Tereshchenko S. N.
Federal State Budgetary Institution, "Russian Cardiology Research and Production Complex" of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: NT-proBNP, circulatory decompensation, risk stratification, CHF

DOI: 10.18087/rhfj.2015.4.2156

Background. Monitoring of brain natriuretic peptide (BNP) and / or N-terminal pro-BNP (NT-proBNP) concentrations has presently the highest recommendation class for the use in diagnostics and risk stratification of CHF. Aim. To study efficacy of treatment based on NT-proBNP level monitoring in patients at high risk after acute HF decompensation (AHFD), Materials and methods. The study included 100 patients with IHD, AHFD or AH with severe, decompensated FC III–IV CHF and LV EF <40 %. After stabilization of clinical condition, before the discharge from a hospital, patients were divided, based on their NT-BNP level, into groups of low (NT-proBNP <1400 pg / ml) (n=30) and high risk (NT-proBNP ≥1400 pg / ml) (n=70). High-risk patients were randomized to two main treatment groups, a group of BNP concentration monitoring (BNPCM) (n=35) and a group of standard therapy (n=35). At the end of study, an additional group of high-risk patients who were noncompliant with the protocol was formed out of patients from these two groups (n=10). The groups practically did not differ from each other in major clinical and functional characteristics. The goal of treatment was decreasing the NT-proBNP concentration to below 1000 pg / ml and / or ≥50 % from baseline. At the time of discharge from the hospital, median NT-proBNP concentration was 3750.0 (2 224.0; 6 613.0) pg / ml in the BNPCM group, 2 783.0 (2021.5; 4 827.5) pg / ml in the standard therapy group, and 2162.0 (1684.5; 5750.0) pg / ml in the noncompliant patient group (р=0.315). Results. All patients of BNPCM and standard therapy groups received a combination of ACEI / ARB, BB, and MRA. At 6 months, changes in drug doses were greater in the BNPCM group than in the standard therapy group. Over the treatment period, the peptide concentration decreased by 53.0 % (р=0.001) in the BNPCM group and by 10.2 % in the standard therapy group (р=0.001 between groups). The NT-proBNP-guided therapy compared to the standard therapy significantly decreased the incidence of adverse cardiovascular (CV) events, including CV death (4 vs. 10, р=0.033), recurrent decompensation, and hospitalization for CHF (4 vs. 14, р=0.007). The lowest risk of CV events was observed for patient with a decrease in NT-proBNP concentration by >50 % from baseline [OR at 95 % CI 0.08 (0.02–0.36), p<0.0001] (74 % of BNPCM group) or for patients who achieved the peptide concentration <988.5 pg / ml for 6 months of treatment following discharge from the hospital. The highest risk of CV events was observed for patients with increased NT-proBNP concentration values during the follow-up period. Conclusion. The NT-proBNP-guided therapy of high-risk patients with CHF reduces incidences of adverse CV events, such as CV death, repeated decompensation, and hospitalization for CHF compared with the standard therapy. A decrease in NT-proBNP concentration by >50 % of baseline at discharge from the hospital is the main provision of success in reducing the risk for CHF patients after an AHFD episode.
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Skvortsov A. A., Koshkina D. E., Protasov V. N., Narusov O. Yu., Masenko V. P., Tereshchenko S. N. Nt-proBNP-guided therapy reduces risk of death and hospitalization in patients after decompensation of heart failure. Russian Heart Failure Journal. 2015;16 (4):204–217

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