Characterization and Prediction of Natriuretic Peptide “Nonresponse” During Heart Failure Management: Results From the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) Study
Many proven heart failure (HF) therapies decrease N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) values over time, yet some patients have an NT‐proBNP >1000 pg/mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction...
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| Veröffentlicht in: | Congestive heart failure (Greenwich, Conn.) Conn.), 2013-05, Vol.19 (3), p.135-142 |
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| creator | Gaggin, Hanna K. Truong, Quynh A. Rehman, Shafiq U. Mohammed, Asim A. Bhardwaj, Anju Parks, Kimberly A. Sullivan, Dorothy A. Chen‐Tournoux, Annabel Moore, Stephanie A. Richards, A. Mark Troughton, Richard W. Lainchbury, John G. Weiner, Rory B. Baggish, Aaron L. Semigran, Marc J. Januzzi, James L. |
| description | Many proven heart failure (HF) therapies decrease N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) values over time, yet some patients have an NT‐proBNP >1000 pg/mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction were treated with aggressive HF therapy in the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Clinical characteristics and NT‐proBNP were measured at each visit during 10 months. In this post hoc analysis, biomarker nonresponse was defined as an NT‐proBNP >1000 pg/mL and its relationship with echocardiographic and clinical characteristics and outcomes were explored. A risk model predictive of nonresponse was derived and externally validated. A rising NT‐proBNP over time was associated with increased cardiovascular event rates while a decreasing NT‐proBNP was associated with better clinical outcomes (58.2% vs 27.6%, P=.001). A higher percentage of time in biomarker response was associated with lower event rates (P |
| doi_str_mv | 10.1111/chf.12016 |
| format | Article |
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Mark ; Troughton, Richard W. ; Lainchbury, John G. ; Weiner, Rory B. ; Baggish, Aaron L. ; Semigran, Marc J. ; Januzzi, James L.</creator><creatorcontrib>Gaggin, Hanna K. ; Truong, Quynh A. ; Rehman, Shafiq U. ; Mohammed, Asim A. ; Bhardwaj, Anju ; Parks, Kimberly A. ; Sullivan, Dorothy A. ; Chen‐Tournoux, Annabel ; Moore, Stephanie A. ; Richards, A. Mark ; Troughton, Richard W. ; Lainchbury, John G. ; Weiner, Rory B. ; Baggish, Aaron L. ; Semigran, Marc J. ; Januzzi, James L.</creatorcontrib><description>Many proven heart failure (HF) therapies decrease N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) values over time, yet some patients have an NT‐proBNP >1000 pg/mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction were treated with aggressive HF therapy in the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Clinical characteristics and NT‐proBNP were measured at each visit during 10 months. In this post hoc analysis, biomarker nonresponse was defined as an NT‐proBNP >1000 pg/mL and its relationship with echocardiographic and clinical characteristics and outcomes were explored. A risk model predictive of nonresponse was derived and externally validated. A rising NT‐proBNP over time was associated with increased cardiovascular event rates while a decreasing NT‐proBNP was associated with better clinical outcomes (58.2% vs 27.6%, P=.001). A higher percentage of time in biomarker response was associated with lower event rates (P<.001). Importantly, responders showed improved left ventricular remodeling parameters (all P<.001), while nonresponders did not. A risk model for predicting nonresponse had a C statistic of 0.82 (P<.001) and predicted outcomes well. Using data from the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) cohort, the risk score was validated for its ability to predict nonresponse (C statistic 0.73, P<.001). Serial changes in NT‐proBNP inform risk for adverse outcome and are associated with prognostically meaningful metrics. Prediction of future NT‐proBNP nonresponse to HF therapy is possible.</description><identifier>ISSN: 1527-5299</identifier><identifier>EISSN: 1751-7133</identifier><identifier>DOI: 10.1111/chf.12016</identifier><identifier>PMID: 23279139</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Biomarkers - blood ; Echocardiography ; Female ; Follow-Up Studies ; Heart Failure - blood ; Heart Failure - mortality ; Heart Failure - therapy ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Outpatients ; Patient Readmission - trends ; Peptide Fragments - blood ; Prognosis ; Prospective Studies ; Protein Precursors ; Survival Rate - trends ; United States - epidemiology ; Ventricular Function, Left</subject><ispartof>Congestive heart failure (Greenwich, Conn.), 2013-05, Vol.19 (3), p.135-142</ispartof><rights>2012 Wiley Periodicals, Inc.</rights><rights>2013 Wiley Periodicals, Inc</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fchf.12016$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fchf.12016$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27907,27908,45557,45558</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23279139$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gaggin, Hanna K.</creatorcontrib><creatorcontrib>Truong, Quynh A.</creatorcontrib><creatorcontrib>Rehman, Shafiq U.</creatorcontrib><creatorcontrib>Mohammed, Asim A.</creatorcontrib><creatorcontrib>Bhardwaj, Anju</creatorcontrib><creatorcontrib>Parks, Kimberly A.</creatorcontrib><creatorcontrib>Sullivan, Dorothy A.</creatorcontrib><creatorcontrib>Chen‐Tournoux, Annabel</creatorcontrib><creatorcontrib>Moore, Stephanie A.</creatorcontrib><creatorcontrib>Richards, A. Mark</creatorcontrib><creatorcontrib>Troughton, Richard W.</creatorcontrib><creatorcontrib>Lainchbury, John G.</creatorcontrib><creatorcontrib>Weiner, Rory B.</creatorcontrib><creatorcontrib>Baggish, Aaron L.</creatorcontrib><creatorcontrib>Semigran, Marc J.</creatorcontrib><creatorcontrib>Januzzi, James L.</creatorcontrib><title>Characterization and Prediction of Natriuretic Peptide “Nonresponse” During Heart Failure Management: Results From the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) Study</title><title>Congestive heart failure (Greenwich, Conn.)</title><addtitle>Congest Heart Fail</addtitle><description>Many proven heart failure (HF) therapies decrease N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) values over time, yet some patients have an NT‐proBNP >1000 pg/mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction were treated with aggressive HF therapy in the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Clinical characteristics and NT‐proBNP were measured at each visit during 10 months. In this post hoc analysis, biomarker nonresponse was defined as an NT‐proBNP >1000 pg/mL and its relationship with echocardiographic and clinical characteristics and outcomes were explored. A risk model predictive of nonresponse was derived and externally validated. A rising NT‐proBNP over time was associated with increased cardiovascular event rates while a decreasing NT‐proBNP was associated with better clinical outcomes (58.2% vs 27.6%, P=.001). A higher percentage of time in biomarker response was associated with lower event rates (P<.001). Importantly, responders showed improved left ventricular remodeling parameters (all P<.001), while nonresponders did not. A risk model for predicting nonresponse had a C statistic of 0.82 (P<.001) and predicted outcomes well. Using data from the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) cohort, the risk score was validated for its ability to predict nonresponse (C statistic 0.73, P<.001). Serial changes in NT‐proBNP inform risk for adverse outcome and are associated with prognostically meaningful metrics. Prediction of future NT‐proBNP nonresponse to HF therapy is possible.</description><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Outpatients</subject><subject>Patient Readmission - trends</subject><subject>Peptide Fragments - blood</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Protein Precursors</subject><subject>Survival Rate - trends</subject><subject>United States - epidemiology</subject><subject>Ventricular Function, Left</subject><issn>1527-5299</issn><issn>1751-7133</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdksuO0zAUhgMCMcPAghdAlmDRWXTGjpvEZtdJW4pU2qoN68gkJ1OPcsN2hMqqj4DEFl6uT8JpZkCCbGzL33-xcjzvFaNXDL_rbFdcMZ-y8LF3zqKADSPG-RPcB340DHwpz7zn1t5RGnAu5DPvzOd-JBmX54_exjtlVObA6G_K6aYmqs7J2kCus_7YFGSpnNGdAaczsobW6RzI8fBz2dQGbNvUFo6HX2TSGV3fkjko48hM6RIV5KOq1S1UULt3ZAO2K50lM9NUxO0AU5qb5ZqsOtdiNDIkQVmD2STemabGuH_dBuvNKpnGyWVf8mSxTI6H723vczz8GFurrUN5YkC5UypxDVmAtVCTLT5RlSRWJtcqwzYqrzQKsH9vN0HJjgxuxkmymG7j8WYznVySrevy_QvvaaFKCy8f1gvv02yaxPPhYvX-QzxeDFsmR-FQcKY4FTJSmQqBSeGHDHwBQT6SXGZCFP4oL0TGoiJnRSFyKpVE3I8UhIWg_MIb3Pvii750YF2KDTMoS1VD09mU8XAUUUHpCX3zH3rXdKbGdkgF0Uj4jDKkXj9Q3ecK8rQ1ulJmn_75_whc3wNfdQn7v_eMpqfBSnGw0n6w0ng-6zf8N21hxTo</recordid><startdate>201305</startdate><enddate>201305</enddate><creator>Gaggin, Hanna K.</creator><creator>Truong, Quynh A.</creator><creator>Rehman, Shafiq U.</creator><creator>Mohammed, Asim A.</creator><creator>Bhardwaj, Anju</creator><creator>Parks, Kimberly A.</creator><creator>Sullivan, Dorothy A.</creator><creator>Chen‐Tournoux, Annabel</creator><creator>Moore, Stephanie A.</creator><creator>Richards, A. 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Mark</creatorcontrib><creatorcontrib>Troughton, Richard W.</creatorcontrib><creatorcontrib>Lainchbury, John G.</creatorcontrib><creatorcontrib>Weiner, Rory B.</creatorcontrib><creatorcontrib>Baggish, Aaron L.</creatorcontrib><creatorcontrib>Semigran, Marc J.</creatorcontrib><creatorcontrib>Januzzi, James L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Congestive heart failure (Greenwich, Conn.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gaggin, Hanna K.</au><au>Truong, Quynh A.</au><au>Rehman, Shafiq U.</au><au>Mohammed, Asim A.</au><au>Bhardwaj, Anju</au><au>Parks, Kimberly A.</au><au>Sullivan, Dorothy A.</au><au>Chen‐Tournoux, Annabel</au><au>Moore, Stephanie A.</au><au>Richards, A. Mark</au><au>Troughton, Richard W.</au><au>Lainchbury, John G.</au><au>Weiner, Rory B.</au><au>Baggish, Aaron L.</au><au>Semigran, Marc J.</au><au>Januzzi, James L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization and Prediction of Natriuretic Peptide “Nonresponse” During Heart Failure Management: Results From the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) Study</atitle><jtitle>Congestive heart failure (Greenwich, Conn.)</jtitle><addtitle>Congest Heart Fail</addtitle><date>2013-05</date><risdate>2013</risdate><volume>19</volume><issue>3</issue><spage>135</spage><epage>142</epage><pages>135-142</pages><issn>1527-5299</issn><eissn>1751-7133</eissn><abstract>Many proven heart failure (HF) therapies decrease N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) values over time, yet some patients have an NT‐proBNP >1000 pg/mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction were treated with aggressive HF therapy in the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Clinical characteristics and NT‐proBNP were measured at each visit during 10 months. In this post hoc analysis, biomarker nonresponse was defined as an NT‐proBNP >1000 pg/mL and its relationship with echocardiographic and clinical characteristics and outcomes were explored. A risk model predictive of nonresponse was derived and externally validated. A rising NT‐proBNP over time was associated with increased cardiovascular event rates while a decreasing NT‐proBNP was associated with better clinical outcomes (58.2% vs 27.6%, P=.001). A higher percentage of time in biomarker response was associated with lower event rates (P<.001). Importantly, responders showed improved left ventricular remodeling parameters (all P<.001), while nonresponders did not. A risk model for predicting nonresponse had a C statistic of 0.82 (P<.001) and predicted outcomes well. Using data from the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) cohort, the risk score was validated for its ability to predict nonresponse (C statistic 0.73, P<.001). Serial changes in NT‐proBNP inform risk for adverse outcome and are associated with prognostically meaningful metrics. Prediction of future NT‐proBNP nonresponse to HF therapy is possible.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>23279139</pmid><doi>10.1111/chf.12016</doi><tpages>8</tpages></addata></record> |
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| ispartof | Congestive heart failure (Greenwich, Conn.), 2013-05, Vol.19 (3), p.135-142 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Biomarkers - blood Echocardiography Female Follow-Up Studies Heart Failure - blood Heart Failure - mortality Heart Failure - therapy Humans Male Middle Aged Natriuretic Peptide, Brain - blood Outpatients Patient Readmission - trends Peptide Fragments - blood Prognosis Prospective Studies Protein Precursors Survival Rate - trends United States - epidemiology Ventricular Function, Left |
| title | Characterization and Prediction of Natriuretic Peptide “Nonresponse” During Heart Failure Management: Results From the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT‐proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) Study |
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