Baseline NT-proBNP nonresponse score and health status measures in assessing treatment responses in heart failure with reduced ejection fraction

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2025-05-01 Epub Date: 2025-01-25 DOI:10.1016/j.ahj.2025.01.011

Thanat Chaikijurajai MD , Horng H. Chen MBBCh , W.H. Wilson Tang MD

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Abstract

Background

We aim to validate NT-proBNP nonresponse score (NNRS) previously derived from the PROTECT and BATTLESCARRED studies in comparison with standard health status measures in predicting natriuretic peptide responses in patients with heart failure with reduced ejection fraction.

Methods

Data on the GUIDE-IT trial were used to derive the NNRS based on 4 predictors including baseline NT-proBNP, heart rate, NYHA functional class, and history of atrial fibrillation. The discriminative capacity of the NNRS and health status measures for having NT-proBNP >1,000 pg/mL at 12 months was assessed and compared with baseline or follow-up health status measures including Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS), Duke Activity Status Index (DASI), and 6-minute walk distance. Multivariable logistic regression analysis was used to determine the predictive value of the score and health status measures greater than the median values for NT-proBNP response with adjustment for age, sex, body mass index, comorbidities, baseline creatinine and NT-proBNP levels.

Results

Among 877 patients, 252 (28.7%) patients had NT-proBNP >1,000 pg/mL at 12 months. The discriminative capacity of the NT-proBNP nonresponse score was 0.72 (95% CI, 0.67-0.77). After adjusting for covariates, only NNRS (P = .044) and KCCQ-OSS (P = .002) remained predictive for NT-proBNP nonresponse at 12 months.

Conclusion

NT-proBNP nonresponse score and KCCQ-OSS was associated with persistently elevated NT-proBNP 12 months independently of baseline NT-proBNP levels.

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基线NT-proBNP无反应评分和健康状态测量评估心力衰竭伴射血分数降低的治疗反应。

背景：我们的目的是验证NT-proBNP无反应评分（NNRS）先前从PROTECT和BATTLESCARRED研究中得出，并与标准健康状况测量相比较，以预测射血分数降低的心力衰竭患者的利钠肽反应。方法：使用GUIDE-IT试验的数据，根据基线NT-proBNP、心率、NYHA功能分级和房颤史等4个预测因素得出NNRS。评估NNRS和健康状态测量在12个月时NT-proBNP >1,000 pg/mL的判别能力，并与基线或随访健康状态测量进行比较，包括堪萨斯城心肌病问卷总体总结评分（KCCQ-OSS）、杜克活动状态指数（DASI）和6分钟步行距离。采用多变量logistic回归分析，确定年龄、性别、体重指数、合并症、基线肌酐和NT-proBNP水平调整后评分和健康状况测量值大于NT-proBNP反应中位数的预测值。结果：在877例患者中，252例（28.7%）患者在12个月时NT-proBNP水平为1000 pg/mL。NT-proBNP无反应评分的判别能力为0.72 （95% CI 0.67-0.77）。在调整协变量后，只有NNRS （P= 0.044）和KCCQ-OSS （P= 0.002）在12个月时仍能预测NT-proBNP无反应。结论：NT-proBNP无反应评分和KCCQ-OSS与NT-proBNP持续升高相关，独立于基线NT-proBNP水平12个月。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.