AI Article Synopsis
- This study extended the follow-up of the DANISH trial, focusing on how baseline NT-proBNP levels affect the outcomes of implantable cardioverter-defibrillator (ICD) implantation in patients with non-ischemic systolic heart failure.
- The data showed that patients with lower NT-proBNP levels (below the median) had a significant reduction in all-cause mortality and cardiovascular deaths with ICD compared to standard care, while those with higher levels did not see similar benefits.
- The findings suggest that lower NT-proBNP levels could help identify patients who are more likely to benefit from ICD implantation in treating their heart failure.
Article Abstract
Objectives: In this extended follow-up study of the DANISH (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality) trial, adding 4 years of additional follow-up, we examined the effect of implantable cardioverter-defibrillator (ICD) implantation according to baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) level.
Background: In the DANISH trial, NT-proBNP level at baseline appeared to modify the response to ICD implantation.
Methods: In the DANISH trial, 1,116 patients with nonischemic systolic HF were randomized to receive an ICD (N = 556) or usual clinical care (N = 550). Outcomes were analyzed according to NT-proBNP levels (below/above median) at baseline. The primary outcome was death from any cause.
Results: All 1,116 patients in the DANISH trial had an available NT-proBNP measurement at baseline (median: 1,177 pg/mL; range: 200-22,918 pg/mL). There was a trend toward a reduction in all-cause death with ICD implantation, compared with usual clinical care, in patients with NT-proBNP levels lower than the median (HR: 0.75 [95% CI: 0.55-1.03]), but not in those with higher NT-proBNP levels (HR: 0.95 [95% CI: 0.74-1.21]) (P = 0.28). Similarly, ICD implantation significantly reduced the rate of cardiovascular (CV) and sudden cardiovascular death (SCD) in patients with NT-proBNP levels lower than the median (CV death, HR: 0.69 [95% CI: 0.47-1.00]; SCD, HR: 0.37 [95% CI: 0.19-0.75]), but not in those with higher levels (CV death, HR: 0.94 [95% CI: 0.70-1.25]; SCD, HR: 0.86 [95% CI: 0.49-1.51]) (P = 0.20 and 0.08 for CV death and SCD, respectively).
Conclusions: Lower baseline NT-proBNP levels could identify patients with nonischemic systolic HF who may derive benefit from ICD implantation. (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality [DANISH]; NCT00542945).
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| http://dx.doi.org/10.1016/j.jchf.2022.01.003 | DOI Listing |
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