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Cohen-Solal A, Logeart D, Huang B, et al
J Am Coll Cardiol 2009;53:2343-2348.
Natriuretic peptides (B-type natriuretic peptide [BNP] or N-terminal pro-B-type natriuretic peptide [NT-proBNP] have rapidly gained popularity as biomarkers of diagnostic and prognostic value in patients with acute and chronic heart failure. BNP values at discharge have been shown to be strong predictors of subsequent outcomes in patients admitted for acute decompensation of heart failure. The authors describe a retrospective analysis of results from patients participated in the SURVIVE (Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support) study.
The purpose of this analysis was to determine whether changes in plasma BNP levels within the first 5 days of hospitalisation could predict short- and long-term mortality for patients with severe acute decompensated heart failure (ADHF).
SURVIVE was a randomised, multicentre, international, double-blind, double-dummy, parallel group, active-controlled study of levosimendan versus dobutamine in patients with severe ADHF.* The primary endpoint of the SURVIVE study was all-cause mortality at 180 days. Among secondary endpoints were BNP concentrations from the initiation of study drug (at baseline) to 24 hours. In addition, BNP concentrations were determined at Day 3 and 5. Mortality was evaluated at Days 1, 5, 14 and Day 31 and 180.
With regard to the percentage change in BNP from baseline to Day 5 the patients were divided into
responders
(decrease ≥30%) or
nonresponders
(decrease <30%). Another definition of responders was patients with an absolute BNP level of <800 pg/ml at Day 5. In total, 1038 patients who had BNP samples taken at both baseline and at Day 5 were included in the analysis.
BNP-responders at Day 5 had a 67% risk reduction in 31-day mortality compared with nonresponders (p<0.001). For 180-day mortality, the risk reduction was 47% (p<0.0001). Mortality rate at Day 31 was 4.6% for responders compared with 13.1% for nonresponders. The 180-day mortality rate was 17.9% for responders compared with 30.3% for nonresponders.
Occurrence of cardiogenic shock, cardiac failure and ventricular tachycardia was significantly less in the responder group. Moreover, there was a significant difference between responders and nonresponders regarding overall serious adverse events 22% (119 of 549) of responders, and 32% (158 of 489) of nonresponders had serious events during the study period.
This retrospective analysis of the SURVIVE study showed that a decrease in BNP of ≥30% during the first 5 days of hospitalisation of patients with ADHF was positively associated with improved survival at 31 days and 180 days.
* Mebazaa A. Nieminen MS, Packer M, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure. The SURVIVE randomized trial. JAMA 2007; 297:1883-1891.
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