Abstract 17300: Changes in Natriuretic Peptides After Hospitalization for Heart Failure With Preserved Ejection Fraction: A Feasible Surrogate Endpoint? A Report From the Prospective Karen Study
Introduction: Changes in natriuretic peptide (NP) have been demonstrated to correlate with outcomes in patients with heart failure (HF). However, it is unknown whether the variations between their levels at the time of hospitalization for decompensation of HF with preserved ejection fraction (HFPEF) and at the follow-up visit could represent a prognostic tool and thus also a potential surrogate end-point for randomized trials assessing the efficacy of drugs initiated in the acute phase of HFPEF.
Hypothesis: To assess: (1)what clinical characteristics in the acute setting were associated with lower NPs in the acute setting and with the improvement in NP levels at the follow-up; (2)whether changes in NPs from hospitalization to follow-up are associated with outcomes.
Methods: Patients hospitalized for decompensated HFPEF enrolled in the Karolinska Rennes (KaRen) study and reporting N-terminal pro-B-type NP or B-type NP assessment at baseline and at 4-8 weeks follow-up were prospectively studied. Logistic regression analyses were performed to detect the predictors of baseline and changes in NPs. Cox’s regression models were performed using mortality and the composite of mortality and HF hospitalization as outcomes to detect any difference in prognosis between patients reporting a decrease vs. an increase in NPs.
Results: Of 361 patients (median follow-up 585 days), 267(74%) reported an improve in NPs, while 94(26%) reported a worsening. At the baseline, the only independent predictor of lower NPs was higher glomerular filtration rate (OR:1.013; 95%CI:1.005-1.021), while the improve of NPs at the follow-up was predicted by higher heart rate (OR:1.014; 95%CI:1.003-1.025). After adjustments, the hazard ratio for all-cause death was 0.705 (95%CI:0.439-1.132) and that for the composite outcome was 0.820 (95%CI: 0.586-1.148) in patients improving vs. those worsening NPs at follow-up.
Conclusions: Changes in NPs from the hospital admission to the follow-up evaluation were not associated to mortality and morbidity in decompensated HFPEF. This evidence does not support the evaluation of changes in NPs as a prognostic tool or as a surrogate end-point for randomized trials assessing the efficacy of drugs initiated in the acute phase of HFPEF.
Author Disclosures: G. Savarese: None. E. Donal: None. C. Hage: None. E. Oger: None. H. Persson: None. J. Daubert: None. C. Linde: None. L.H. Lund: None.
- © 2016 by American Heart Association, Inc.