Changes in Brain Natriuretic Peptide and Norepinephrine Over Time and Mortality and Morbidity in the Valsartan Heart Failure Trial (Val-HeFT)

Ovid Technologies (Wolters Kluwer Health) - Tập 107 Số 9 - Trang 1278-1283 - 2003
Inder S. Anand1,2,3,4,5,6, Lloyd D. Fisher1,2,3,5,7,6, YannTong Chiang1,2,3,5,6,8, Roberto Latini1,2,3,5,9,6, Serge Masson1,2,3,5,10,6, Aldo P. Maggioni1,2,3,5,11,6, Robert Glazer1,2,3,5,11,6, Gianni Tognoni1,2,3,12,5,6, Jay N. Cohn1,2,3,5,11,6
1ANMCO Research Center (A.P.M.), Florence, Italy
2Department of Biostatistics (L.D.F.), University of Washington, Seattle, Wash
3From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn; Department of Biostatistics (L.D.F.), University of Washington, Seattle, Wash; Novartis Pharmaceuticals Corporation (Y.-T.C., R.D.G.), East Hanover, NJ; Istituto “Mario Negri” (R.L., S.M., G.T.), Milan, Italy; ANMCO Research Center (A.P.M.), Florence, Italy; and University of Minnesota (J.N.C.), Minneapolis, Minn.
4Inder S. Anand From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn
5Istituto "Mario Negri" (R.L., S.M., G.T.), Milan, Italy
6University of Minnesota (J.N.C.), Minneapolis, Minn.
7Lloyd D. Fisher From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn
8Yann-Tong Chiang From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn
9Roberto Latini From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn
10Serge Masson From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn
11Novartis Pharmaceuticals Corporation (Y.-T.C., R.D.G.), East Hanover, NJ
12Gianni Tognoni From the VA Medical Center and University of Minnesota (I.S.A.), Minneapolis, Minn

Tóm tắt

Background— Neurohormones are considered markers of heart failure progression. We examined whether changes in brain natriuretic peptide (BNP) and norepinephrine (NE) over time are associated with corresponding changes in mortality and morbidity in the Valsartan Heart Failure Trial. Methods and Results— Plasma BNP and NE were measured before randomization and during follow-up in ≈4300 patients in the Valsartan Heart Failure Trial. The relation between baseline BNP and NE and all-cause mortality and first morbid event (M&M) was analyzed in subgroups, with values above and below the median, and by quartiles. The change and percent change from baseline to 4 and 12 months in BNP and NE were also analyzed by quartiles for subsequent M&M. Risk ratios for M&M were calculated using a Cox proportional hazard model. Risk ratio of M&M for patients with baseline BNP or NE above the median was significantly higher than that for patients with values below the median. Baseline BNP and NE in quartiles also showed a quartile-dependent increase in M&M. BNP had a stronger association with M&M than NE. Patients with the greatest percent decrease in BNP and NE from baseline to 4 and 12 months had the lowest whereas patients with greatest percent increase in BNP and NE had the highest M&M. Conclusions— Not only are plasma BNP and NE important predictors of heart failure M&M, but changes in these neurohormones over time are associated with corresponding changes in M&M. These data further reinforce their role as significant surrogate markers in HF and underscore the importance of including their measurement in HF trials.

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Ovid Technologies (Wolters Kluwer Health)

Tập 107 Số 9

1278-1283

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