Background
Recent studies of patients with HFrEF have suggested that lower baseline NT-proBNP
levels are associated with improved morbidity/mortality outcomes with pharmaceutical
treatment. Neuromodulation (NM) using carotid nerve plexus stimulation has also been
associated with better clinical outcomes when baseline NT-proBNP < 1,600 pg/ml. Whether
NT-proBNP may also be a determinant of clinical responsiveness to NM using vagus nerve
stimulation (VNS) has not been examined.
Objective
We evaluated the relationship of baseline NT-proBNP to changes in symptoms and function
in patients during NM using VNS for 6 months in ANTHEM-HF.
Methods
NT-proBNP was collected for exploratory analysis and not used as an inclusion criterion
for the study. A repeated measures, generalized-estimating, equations model evaluated
the relationship of baseline NT-proBNP values above and below 1,600 pg/ml to symptomatic
and functional responses.
Results
The median (interquartile range; maximum) NT-proBNP was 868 (322, 1875; 14,656) pg/ml
(n=58). Heart rate (HR), HR variability (SDNN), 6-minute walk distance, MLWHF mean
score, and NYHA improved significantly at 6 months, independent of baseline NT-proBNP.
While there was a statistical interaction observed between lower baseline NT-proBNP
and better LVEF improvement, LVEF improved clinically in the overall cohort (32±7
to 37±10% [p=0.0042]), and in the two subgroups with NT-proBNP below or above the
median for the study population (36±6 to 42±10% [n=29; p<0.0025] and 29±7 to 32±9%
[n=29; p<0.05], respectively; no significant difference between subgroups).
Conclusions
In ANTHEM-HF, overall symptomatic and functional response to ART was not associated
with baseline NT-proBNP. These findings are preliminary and hypothesis-generating.
The ongoing ANTHEM-HFrEF Pivotal Study (NCT03425422) is likely to provide additional
insight.
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Copyright
© 2020 Published by Elsevier Inc.
