045| Volume 26, ISSUE 10, SUPPLEMENT , S19, October 2020

Relationship of Baseline NT-proBNP to Responsiveness to Vagus Nerve Stimulation in Patients with Heart Failure and Reduced Ejection Fraction


      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.


      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.


      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.


      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).


      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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