Serial ProBNP Measurement: A Cutting-Edge Approach to Systolic Heart Failure

Researchers from Massachusetts General Hospital in Boston presented results from the PROTECT (ProBNP Outpatient Tailored Chronic Heart Failure) study. NT-proBNP (b-type natriuretic peptide) is a biomarker released from myocardial tissue in response to high levels of wall stretch and has been studied as a diagnostic and prognostic marker for congestive heart failure. The use of NT-proBNP has become common in tertiary referral centers but has been slower to penetrate into community-based primary care monitoring and treatment of systolic congestive heart failure.

Weiner’s group randomized 151 subjects with documented systolic dysfunction to either:
•Usual standard of care (SOC): Usual medications were dose-titrated to achieve subjective symptom control, or:
•NT-proBNP-guided strategy: Usual medications were dose-titrated with a goal of lowering NT-proBNPconcentrations below 1000 pg/mL. NT-proBNP was measured approximately every 90 days. Medications were adjusted upward even if patients reported good symptom control.

NT-proBNP did not change in the SOC arm but fell by half in the NT-proBNP arm (2104 vs. 1094 pg/ml; p=.03). Measured endpoint events were heart failure hospitalization, decompensated heart failure, and cardiovascular death. The SOC group experienced 100 such events, the NT-proBNP-guided strategy group only 58. This correlated with significant improvements in cardiac structure and function (left ventricular reverse remodeling) seen on transthoracic echocardiogram. Results suggest that the use of NT-proBNP monitoring may have significant value in the outpatient treatment of patients with medically managed systolic congestive heart failure.   

Weiner RB, et al. Improvement of echocardiographic parameters associated with NT-proBNP-guided heart failure management: mechanistic insights from the proBNP outpatient tailored chronic heart failure (PROTECT) study. Presented at ACC 2011. April 3, 2011. New Orleans, La.

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