Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan
Abstract Aims Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted. Methods and results Six hundred thirty‐two patients with heart failure with...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-10-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14503 |
| _version_ | 1797661453061193728 |
|---|---|
| author | Reza Mohebi Yuxi Liu Javed Butler G. Michael Felker Jonathan H. Ward Margaret F. Prescott Ileana L. Piña Scott D. Solomon James L. Januzzi Jr |
| author_facet | Reza Mohebi Yuxi Liu Javed Butler G. Michael Felker Jonathan H. Ward Margaret F. Prescott Ileana L. Piña Scott D. Solomon James L. Januzzi Jr |
| author_sort | Reza Mohebi |
| collection | DOAJ |
| description | Abstract Aims Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted. Methods and results Six hundred thirty‐two patients with heart failure with reduced ejection fraction (<40%) and complete biomarker data were enrolled to receive sacubitril/valsartan. Patients underwent periodic study visits during 1‐year follow‐ups. Echocardiographic data and cardiac biomarkers, including N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) were collected during study visits. Patients were categorized into three groups based on tertiles of baseline NT‐proBNP levels. The area under the curve (AUC) of NT‐proBNP measurements across study visits was calculated. Compared with patients with higher AUC (and thus higher concentrations over a longer period of time), those with lower AUC were younger, had a lower prevalence of chronic kidney disease, prior coronary artery bypass graft, atrial fibrillation, and higher body‐mass index. A significant interaction existed between baseline NT‐proBNP and subsequent AUC for predicting LVEF change across visits (P‐value < 0.001): among those with lower baseline NT‐proBNP, similar improvements in left ventricular (LV) volumes LV ejection fraction, and LV mass index were observed across subsequent AUC (P‐value > 0.1). However, among those with higher baseline NT‐proBNP, those with lower subsequent AUC had a greater improvement in cardiac remodelling indices (P‐value < 0.05). Conclusions Serial NT‐proBNP monitoring (integrating the totality of measurements as an AUC) during treatment with sacubitril/valsartan informs unique information regarding the future changes in cardiac remodelling indices, especially among those with higher NT‐proBNP levels at baseline. |
| first_indexed | 2024-03-11T18:45:41Z |
| format | Article |
| id | doaj.art-70f8c15ae4a44f15b7ce8094b58c2323 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-11T18:45:41Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-70f8c15ae4a44f15b7ce8094b58c23232023-10-12T02:48:44ZengWileyESC Heart Failure2055-58222023-10-011053133314010.1002/ehf2.14503Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartanReza Mohebi0Yuxi Liu1Javed Butler2G. Michael Felker3Jonathan H. Ward4Margaret F. Prescott5Ileana L. Piña6Scott D. Solomon7James L. Januzzi Jr8Massachusetts General Hospital Boston MA USAMassachusetts General Hospital Boston MA USAUniversity of Mississippi Medical Center Jackson MS USADuke University Medical Center and Duke Clinical Research Institute Durham NC USANovartis Pharmaceuticals East Hanover NJ USANovartis Pharmaceuticals East Hanover NJ USACentral Michigan University Midland MI USAHarvard Medical School Boston MA USAMassachusetts General Hospital Boston MA USAAbstract Aims Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted. Methods and results Six hundred thirty‐two patients with heart failure with reduced ejection fraction (<40%) and complete biomarker data were enrolled to receive sacubitril/valsartan. Patients underwent periodic study visits during 1‐year follow‐ups. Echocardiographic data and cardiac biomarkers, including N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) were collected during study visits. Patients were categorized into three groups based on tertiles of baseline NT‐proBNP levels. The area under the curve (AUC) of NT‐proBNP measurements across study visits was calculated. Compared with patients with higher AUC (and thus higher concentrations over a longer period of time), those with lower AUC were younger, had a lower prevalence of chronic kidney disease, prior coronary artery bypass graft, atrial fibrillation, and higher body‐mass index. A significant interaction existed between baseline NT‐proBNP and subsequent AUC for predicting LVEF change across visits (P‐value < 0.001): among those with lower baseline NT‐proBNP, similar improvements in left ventricular (LV) volumes LV ejection fraction, and LV mass index were observed across subsequent AUC (P‐value > 0.1). However, among those with higher baseline NT‐proBNP, those with lower subsequent AUC had a greater improvement in cardiac remodelling indices (P‐value < 0.05). Conclusions Serial NT‐proBNP monitoring (integrating the totality of measurements as an AUC) during treatment with sacubitril/valsartan informs unique information regarding the future changes in cardiac remodelling indices, especially among those with higher NT‐proBNP levels at baseline.https://doi.org/10.1002/ehf2.14503BiomarkerCardiac remodellingNatriuretic peptideSacubitril/valsartan |
| spellingShingle | Reza Mohebi Yuxi Liu Javed Butler G. Michael Felker Jonathan H. Ward Margaret F. Prescott Ileana L. Piña Scott D. Solomon James L. Januzzi Jr Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan ESC Heart Failure Biomarker Cardiac remodelling Natriuretic peptide Sacubitril/valsartan |
| title | Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan |
| title_full | Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan |
| title_fullStr | Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan |
| title_full_unstemmed | Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan |
| title_short | Importance of the ‘area under the curve’ from serial NT‐proBNP measurements during treatment with sacubitril/valsartan |
| title_sort | importance of the area under the curve from serial nt probnp measurements during treatment with sacubitril valsartan |
| topic | Biomarker Cardiac remodelling Natriuretic peptide Sacubitril/valsartan |
| url | https://doi.org/10.1002/ehf2.14503 |
| work_keys_str_mv | AT rezamohebi importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT yuxiliu importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT javedbutler importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT gmichaelfelker importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT jonathanhward importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT margaretfprescott importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT ileanalpina importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT scottdsolomon importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan AT jamesljanuzzijr importanceoftheareaunderthecurvefromserialntprobnpmeasurementsduringtreatmentwithsacubitrilvalsartan |