NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study
This study examined the effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with...
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| Veröffentlicht in: | JACC. Heart failure 2020-10, Vol.8 (10), p.822-833 |
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| container_title | JACC. Heart failure |
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| creator | Pascual-Figal, Domingo Wachter, Rolf Senni, Michele Bao, Weibin Noè, Adele Schwende, Heike Butylin, Dmytro Prescott, Margaret F |
| description | This study examined the effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response.
NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF).
Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline.
In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p |
| doi_str_mv | 10.1016/j.jchf.2020.05.012 |
| format | Article |
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NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF).
Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline.
In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor-naive or angiotensin receptor blocker-naive, and no prior myocardial infarction.
In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217).</description><identifier>EISSN: 2213-1787</identifier><identifier>DOI: 10.1016/j.jchf.2020.05.012</identifier><identifier>PMID: 32800508</identifier><language>eng</language><publisher>United States</publisher><ispartof>JACC. Heart failure, 2020-10, Vol.8 (10), p.822-833</ispartof><rights>Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32800508$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pascual-Figal, Domingo</creatorcontrib><creatorcontrib>Wachter, Rolf</creatorcontrib><creatorcontrib>Senni, Michele</creatorcontrib><creatorcontrib>Bao, Weibin</creatorcontrib><creatorcontrib>Noè, Adele</creatorcontrib><creatorcontrib>Schwende, Heike</creatorcontrib><creatorcontrib>Butylin, Dmytro</creatorcontrib><creatorcontrib>Prescott, Margaret F</creatorcontrib><creatorcontrib>TRANSITION Investigators</creatorcontrib><title>NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study</title><title>JACC. Heart failure</title><addtitle>JACC Heart Fail</addtitle><description>This study examined the effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response.
NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF).
Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline.
In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor-naive or angiotensin receptor blocker-naive, and no prior myocardial infarction.
In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217).</description><issn>2213-1787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNo1kEFOwzAQRS0kRKvSC7BAXrJJOnacxGVXqpZWqtKqDbCM7MRRHaVJiJ1F2XIRzsLJiKDMZkajp__1P0J3BFwCJJgUbpEec5cCBRd8Fwi9QkNKieeQkIcDNDamgH64TzjnN2jgUQ7gAx-izyh2mrZ-inZ4r0xTV0ZhW-ODSDupbavLyasojWitqLCu8Ko2jbai1B8qwyvV_7-_lkKXXavwTlitKmvwm7bHXi3r0h5aFCq1uq7wshW_xyOO97PosI7X2wgfbJedb9F13puo8WWP0MtyEc9Xzmb7vJ7PNk5DCbEOzQMGHuEygIxNAWimcsmkL6gQLJ8KnzDCvdyXgVKezEBCyEieBsRnhMm-jRF6-NPtA793ytjkpE2qylJUqu5MQpnHQh_AYz16f0E7eVJZ0rT6JNpz8l-c9wP5L3Bz</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Pascual-Figal, Domingo</creator><creator>Wachter, Rolf</creator><creator>Senni, Michele</creator><creator>Bao, Weibin</creator><creator>Noè, Adele</creator><creator>Schwende, Heike</creator><creator>Butylin, Dmytro</creator><creator>Prescott, Margaret F</creator><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>202010</creationdate><title>NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study</title><author>Pascual-Figal, Domingo ; Wachter, Rolf ; Senni, Michele ; Bao, Weibin ; Noè, Adele ; Schwende, Heike ; Butylin, Dmytro ; Prescott, Margaret F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-2f640318b60d49002defb4b5a2aa4f9a514183f5b6ee3bd0b0741fc615414b213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pascual-Figal, Domingo</creatorcontrib><creatorcontrib>Wachter, Rolf</creatorcontrib><creatorcontrib>Senni, Michele</creatorcontrib><creatorcontrib>Bao, Weibin</creatorcontrib><creatorcontrib>Noè, Adele</creatorcontrib><creatorcontrib>Schwende, Heike</creatorcontrib><creatorcontrib>Butylin, Dmytro</creatorcontrib><creatorcontrib>Prescott, Margaret F</creatorcontrib><creatorcontrib>TRANSITION Investigators</creatorcontrib><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pascual-Figal, Domingo</au><au>Wachter, Rolf</au><au>Senni, Michele</au><au>Bao, Weibin</au><au>Noè, Adele</au><au>Schwende, Heike</au><au>Butylin, Dmytro</au><au>Prescott, Margaret F</au><aucorp>TRANSITION Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study</atitle><jtitle>JACC. Heart failure</jtitle><addtitle>JACC Heart Fail</addtitle><date>2020-10</date><risdate>2020</risdate><volume>8</volume><issue>10</issue><spage>822</spage><epage>833</epage><pages>822-833</pages><eissn>2213-1787</eissn><abstract>This study examined the effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response.
NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF).
Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline.
In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor-naive or angiotensin receptor blocker-naive, and no prior myocardial infarction.
In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217).</abstract><cop>United States</cop><pmid>32800508</pmid><doi>10.1016/j.jchf.2020.05.012</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| title | NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study |
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