Back to Search Start Over

Evolution of NT-proBNP During Prerandomization Screening in VICTORIA: Implications for Clinical Outcomes and Efficacy of Vericiguat.

Authors :
Armstrong, Paul W.
Yinggan Zheng
Lund, Lars H.
Butler, Javed
Troughton, Richard W.
Emdin, Michele
Lam, Carolyn S. P.
Ponikowski, Piotr
Blaustein, Robert O.
O'Connor, Christopher M.
Roessig, Lothar
Voors, Adriaan A.
Ezekowitz, Justin A.
Westerhout, Cynthia M.
Source :
Circulation: Heart Failure; Oct2023, Vol. 16 Issue 10, p848-858, 11p
Publication Year :
2023

Abstract

BACKGROUND: Selecting high-risk patients with heart failure with potentially modifiable cardiovascular events is a priority. Our objective was to evaluate NT-proBNP (N-terminal pro-B-type natriuretic peptide) changes during a 30-day screening to establish (1) the frequency and direction of changes; (2) whether a relationship exists between changes in NT-proBNP and the primary composite outcome of cardiovascular death and heart failure hospitalization; and (3) whether changes in NTproBNP relate to vericiguat's clinical benefit. METHODS: VICTORIA (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction) randomized 5050 patients with heart failure with reduced ejection fraction and a recent worsening heart failure event. We studied 3821 patients who had NT-proBNP measured during screening and at randomization. RESULTS: Sixteen hundred exhibited a >20% reduction, 1412 had =20% change, and 809 showed a >20% rise in NT-proBNP levels. As compared with the primary composite outcome of 28.4/100 patient-years (497 events; 31.1%) in patients with a >20% decline in NT-proBNP, those with >20% during screening had worse outcomes; 48.8/100 patient-years (359 events; 44.4%); adjusted hazard ratio, 1.61 (95% CI, 1.39-1.85). Those patients with a =20% change in NT-proBNP had intermediate outcomes; 39.2/100 patient-years (564 events; 39.9%); adjusted hazard ratio, 1.33 (95% CI, 1.17-1.51). No relationship existed between NT-proBNP changes during screening and vericiguat's effect on cardiovascular death and heart failure hospitalization. CONCLUSIONS: Substantial differences occurred in the rates of cardiovascular death and heart failure hospitalization, especially in patients with a >20% change in NT-proBNP levels during screening interval. Sequential NT-proBNP levels add important prognostic information meriting consideration in future heart failure trials. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
19413289
Volume :
16
Issue :
10
Database :
Supplemental Index
Journal :
Circulation: Heart Failure
Publication Type :
Academic Journal
Accession number :
173243568
Full Text :
https://doi.org/10.1161/CIRCHEARTFAILURE.123.010661