Author + information
- Received April 20, 2015
- Revision received May 29, 2015
- Accepted May 31, 2015
- Published online October 1, 2015.
- Khibar Salah, MD∗,
- Wouter E. Kok, MD, PhD∗,
- Luc W. Eurlings, MD†,
- Paulo Bettencourt, MD, PhD‡,
- Joana M. Pimenta, MD, PhD‡,
- Marco Metra, MD, PhD§,
- Valerio Verdiani, MD, PhD‖,
- Jan G. Tijssen, PhD∗ and
- Yigal M. Pinto, MD, PhD∗∗ ()
- ∗Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- †Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands
- ‡Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
- §Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
- ‖Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
- ↵∗Reprint requests and correspondence:
Dr. Yigal M. Pinto, Heart Failure Research Center, Academic Medical Center, Meibergdreef 15, K2-119, 1105 AZ Amsterdam, the Netherlands.
Objectives The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF).
Background Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters.
Methods This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge.
Results A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables.
Conclusions When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF.
Drs. Eurling and Pinto have received research funding for their original study from the Dutch Heart Foundation, Dutch Organisation for Scientific Research (NWO), Royal Dutch Academy of Arts and Sciences–Interuniversity Cardiology Institute of the Netherlands, Pfizer, AstraZeneca, and Medtronic. Dr. Pinto has received compensation for lectures and speaker bureau membership and has received research grants from Roche Diagnostics; and holds a patent and owns stock in a university spinoff company. Dr. Kok has received a grant from Dutch Heart Foundation for an unrelated study. Dr. Bettencourt is a paid consultant with Boehringer-Ingelheim; and has received grants from FCT-Portuguese Science and Technology Foundation and payment for lectures and service on the speakers bureau of Servier. Dr. Metra is a member of the board of Corthera and Novartis; and receives payment for lectures and service on speakers bureau from Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 20, 2015.
- Revision received May 29, 2015.
- Accepted May 31, 2015.
- American College of Cardiology Foundation