N-terminal pro-B-type natriuretic peptide-guided therapy in patients hospitalized for acute heart failure

被引：21

作者：

Carubelli, Valentina ^{[1
,2
]}

Lombardi, Carlo ^{[1
,2
]}

Lazzarini, Valentina ^{[1
,2
]}

Bonadei, Ivano ^{[1
,2
]}

Castrini, Anna I. ^{[1
,2
]}

Gorga, Elio ^{[1
,2
]}

Richards, Arthur M. ^{[3
]}

Metra, Marco ^{[1
,2
]}

机构：

[1] Univ Brescia, Dept Med & Surg Specialties, Div Cardiol, Radiol Sci & Publ Hlth, Brescia, Italy

[2] Civil Hosp Brescia, Brescia, Italy

[3] Natl Univ Singapore, Cardiovasc Res Inst, Singapore, Singapore

来源：

JOURNAL OF CARDIOVASCULAR MEDICINE | 2016年 / 17卷 / 11期

关键词：

acute heart failure; guided therapy; natriuretic peptides; NT-proBNP; STANDARD MEDICAL THERAPY; EUROPEAN-SOCIETY; ELDERLY-PATIENTS; TASK-FORCE; MANAGEMENT; DISCHARGE; TRIAL; ASSOCIATION; GUIDELINES; MORTALITY;

D O I：

10.2459/JCM.0000000000000419

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundIn patients with acute heart failure, high levels of N-terminal-pro-brain natriuretic peptide (NT-proBNP) at discharge are associated with worse outcomes. We hypothesized that NT-proBNP-guided therapy may improve prognosis.Methods and resultsTwo hundred and seventy-one consecutive patients, admitted for acute heart failure, were prospectively randomized to NT-proBNP-guided therapy or control group. The NT-proBNP-guided therapy group underwent medical treatment intensification when predischarge NT-proBNP was at least 3000pg/ml. The primary endpoint was cardiovascular death or cardiovascular rehospitalization at day 182. The secondary endpoints were all-cause death, cardiovascular death, cardiovascular rehospitalization, heart failure rehospitalization, and cardiovascular death or heart failure rehospitalization at day 182. Treatment intensification in the NT-proBNP-guided therapy group regarded mainly diuretics. The NT-proBNP strategy was not associated with a significant reduction of the primary endpoint [43% intervention vs. 39% controls, hazard ratio 1.22 (0.84, 1.76), P=0.305] and of any secondary endpoint. The change of NT-proBNP from predischarge to discharge was associated with the risk of cardiovascular death or cardiovascular rehospitalization through day 182, even after multivariable adjustment.ConclusionNT-proBNP-guided therapy resulted mainly in an increase of diuretics in acute setting and compared with clinical evaluation alone did not improve prognosis. However, the reduction of NT-proBNP at discharge was an independent predictor of outcomes.

引用

页码：828 / 839

页数：12

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