TY - JOUR
T1 - N-Terminal Pro-B-Type Natriuretic Peptide and Clinical Outcomes
AU - Ezekowitz, Justin A.
AU - O'Connor, Christopher M.
AU - Troughton, Richard W.
AU - Alemayehu, Wendimagegn G.
AU - Westerhout, Cynthia M.
AU - Voors, Adriaan A.
AU - Butler, Javed
AU - Lam, Carolyn S. P.
AU - Ponikowski, Piotr
AU - Emdin, Michele
AU - Patel, Mahesh J.
AU - Pieske, Burkert
AU - Roessig, Lothar
AU - Hernandez, Adrian F.
AU - Armstrong, Paul W.
PY - 2020/11
Y1 - 2020/11
N2 - OBJECTIVES The purpose of this study was to examine the treatment effect of vericiguat in relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at randomization.BACKGROUND Vericiguat compared with placebo reduced the primary outcome of cardiovascular death (CVD) or heart failure hospitalization (HFH) in patients with HF with reduced ejection fraction (HFrEF) in the VICTORIA (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction) trial. Because an interaction existed between treatment and the primary outcome according to pre-specified quartiles of NT-proBNP at randomization, we examined this further.METHODS This study evaluated the NT-proBNP relationship with the primary outcome in 4,805 of 5,050 patients as a risk-adjusted, tog-transformed continuous variable. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented.RESULTS Median NT-proBNP was 2,816 pg/ml (25th to 75th percentile: 1,556 to 5,314 pg/ml). The study treatment effect varied across the spectrum of NT-proBNP at randomization (with log(2) transformation, p for interaction = 0.002). A significant association between treatment effects existed in patients with levels 8,000 pg/ml (n = 672), the HR was 1.16 (95% CI: 0.94 to 1.41) for the primary outcome.CONCLUSIONS A reduction in the primary composite endpoint and its CVD and HFH components was observed in patients on vericiguat compared with subjects on placebo with NT-proBNP levels up to 8,000 pg/ml. This provided new insight into the benefit observed in high-risk patients with worsening HFrEF. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
AB - OBJECTIVES The purpose of this study was to examine the treatment effect of vericiguat in relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at randomization.BACKGROUND Vericiguat compared with placebo reduced the primary outcome of cardiovascular death (CVD) or heart failure hospitalization (HFH) in patients with HF with reduced ejection fraction (HFrEF) in the VICTORIA (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction) trial. Because an interaction existed between treatment and the primary outcome according to pre-specified quartiles of NT-proBNP at randomization, we examined this further.METHODS This study evaluated the NT-proBNP relationship with the primary outcome in 4,805 of 5,050 patients as a risk-adjusted, tog-transformed continuous variable. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented.RESULTS Median NT-proBNP was 2,816 pg/ml (25th to 75th percentile: 1,556 to 5,314 pg/ml). The study treatment effect varied across the spectrum of NT-proBNP at randomization (with log(2) transformation, p for interaction = 0.002). A significant association between treatment effects existed in patients with levels 8,000 pg/ml (n = 672), the HR was 1.16 (95% CI: 0.94 to 1.41) for the primary outcome.CONCLUSIONS A reduction in the primary composite endpoint and its CVD and HFH components was observed in patients on vericiguat compared with subjects on placebo with NT-proBNP levels up to 8,000 pg/ml. This provided new insight into the benefit observed in high-risk patients with worsening HFrEF. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
KW - clinical outcomes
KW - heart failure
KW - heart failure with reduced ejection fraction
KW - natriuretic peptide
KW - REDUCED EJECTION FRACTION
KW - HEART-FAILURE
U2 - 10.1016/j.jchf.2020.08.008
DO - 10.1016/j.jchf.2020.08.008
M3 - Article
VL - 8
SP - 931
EP - 939
JO - JACC. Heart failure
JF - JACC. Heart failure
SN - 2213-1779
IS - 11
ER -