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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).
Eur J Heart Fail. 2013 Oct; 15(10):1148-56.EJ

Abstract

AIMS

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).

METHODS AND RESULTS

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.

CONCLUSIONS

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. Trial registration ISRCTN43596477.

Authors+Show Affiliations

Division of Cardiology, University Hospital Basel, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23657728

Citation

Maeder, Micha T., et al. "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)." European Journal of Heart Failure, vol. 15, no. 10, 2013, pp. 1148-56.
Maeder MT, Rickenbacher P, Rickli H, et al. 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). Eur J Heart Fail. 2013;15(10):1148-56.
Maeder, M. T., Rickenbacher, P., Rickli, H., Abbühl, H., Gutmann, M., Erne, P., Vuilliomenet, A., Peter, M., Pfisterer, M., & Brunner-La Rocca, H. P. (2013). 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). European Journal of Heart Failure, 15(10), 1148-56. https://doi.org/10.1093/eurjhf/hft076
Maeder MT, et al. 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). Eur J Heart Fail. 2013;15(10):1148-56. PubMed PMID: 23657728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Maeder,Micha T, AU - Rickenbacher,Peter, AU - Rickli,Hans, AU - Abbühl,Heidi, AU - Gutmann,Marc, AU - Erne,Paul, AU - Vuilliomenet,André, AU - Peter,Martin, AU - Pfisterer,Matthias, AU - Brunner-La Rocca,Hans-Peter, AU - ,, Y1 - 2013/05/08/ PY - 2013/5/10/entrez PY - 2013/5/10/pubmed PY - 2014/5/8/medline KW - Biomarker KW - Heart failure KW - Natriuretic peptide KW - Preserved ejection fraction SP - 1148 EP - 56 JF - European journal of heart failure JO - Eur. J. Heart Fail. VL - 15 IS - 10 N2 - AIMS: 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). METHODS AND RESULTS: 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. CONCLUSIONS: 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. Trial registration ISRCTN43596477. SN - 1879-0844 UR - https://www.unboundmedicine.com/medline/citation/23657728/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__ L2 - https://doi.org/10.1093/eurjhf/hft076 DB - PRIME DP - Unbound Medicine ER -