Clin Res Cardiol 101, Suppl 1, April 2012

P693 - Use of MR-proANP and NT-proBNP in the timing of beta blocker up-titration in elderly patients with stable chronic heart failure: Data from the CIBIS-ELD trial
N. Sekularac1, S. von Haehling2, G. Loncar1, E. Tahirovic3, S. Inkrot3, S. Apostolovic4, B. Putnikovic5, W. Haverkamp6, F. Waagstein7, G. Gelbrich8, H.-D. Düngen3 on behalf of KNHI
1Cardiology, Zvezdara University Hospital, Belgrade, Serbien und Montenegro; 2Medizinische Klinik m. S. Kardiologie, Angewandte Kachexieforschung, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; 3Medizinische Klinik m. S. Kardiologie, Kompetenznetz Herzinsuffizienz, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; 4Department of Cardiology, Clinical Center Nis, Clinical Center Nis, Nis, Serbien und Montenegro; 5Cardiology, Zemun University Hospital, Belgrade, Serbien und Montenegro; 6CC11, Medizinische Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin; 7Department of Molecular and Clinical Medicine - Cardiology, Sahlgrenska University, Wallenberg Laboratory for Cardiovascular Research, Göteborg, Schweden; 8Koordinierungszentrum für Klinische Studien Leipzig (KKSL), Universität Leipzig, Leipzig;
Purpose: Clinical parameters are usually used for beta-blocker (BB) up-titration in patients with chronic heart failure (CHF) despite known limitations. No study has evaluated the potential role of cardiac biomarkers for determination of optimal time point for initiation of BB up-titration in stable patients with CHF. Using data from the CIBIS-ELD study, we sought to investigate if the baseline value of mid-regional pro-atrial natriuretic peptide (MR-proANP), N-terminal pro B-type natriuretic peptide (NT-proBNP), and pro-vasopressin (copeptin) may help to find the optimal time point for BB up-titration, and complement patients’ clinical status in every day clinical life.
Methods: We measured MR-proANP, NT-proBNP, and copeptin in 457 elderly patients (≥65 years) with stable systolic CHF (LVEF≤45%) before initiation of BB up-titration. According to predefined cut-off values of respective biomarkers, patients were divided into three subgroups (low, intermediate, high biomarker group) and compared with each other. Additionally, New York Heart Association (NYHA) functional class and echocardiographic examination were performed at baseline and 3 months after BB up-titration.
Results: After 3 months of BB up-titration in the overall study population, we noted significant improvement of left ventricular ejection fraction (LVEF) (from 34.5 ± 8.1 to 38.3 ± 8.9%, p<0.001), left ventricular end-systolic diameter (from 48.2 ± 9.7 to 47.2 ± 9.8mm, p<0.001), and NYHA functional class (from 2.3 ± 0.6 to 2.0 ± 0.6, p<0.001). In all MR-proANP and NT-proBNP subgroups there was significant amelioration of LVEF and NYHA class (p<0.001 for all). However, we showed more prominent improvement of LVEF and NYHA class in patients subgroups with lower vs. higher natriuretic peptides (NP) levels (LVEF: low vs. high subgroup of MR-proANP and NT-proBNP, p=0.003 and p<0.001, respectively; NYHA: both p<0.05). Similarly, reverse left ventricular remodeling was more prominent in low NP vs. high NP subgroup (p<0.05 for both). Unlike NP subgroups, copeptin subgroups did not differ in respect to studied parameters after BB up-titration.
Conclusions: We found that stable CHF patients mirrored by lower NP levels may be expected to have more benefit after initiation of BB up-titration in terms of well-being, reverse left ventricular remodeling, and left ventricular function. Thus, both MR-proANP and NT-proBNP may guide the optimal timing of BB up-titration in stable elderly patients with CHF.
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6