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

April 4, 2011
Jeffrey Hertzberg, MD, MS

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 marker for decompensated 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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