• Gianluigi Savarese, Camilla Hage, Nicola Orsini, Ulf Dahlström, Pasquale Perrone-Filardi, Giuseppe M C Rosano, and Lars H Lund.
• From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George's University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.). gianluigi.savarese@ki.se.
• Circ Heart Fail. 2016 Nov 1; 9 (11).

BackgroundIn heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF), feasible surrogate end points are needed for phase II trials. The aim was to assess whether a reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with improved mortality/morbidity in an unselected population of HFmrEF and HFpEF patients.Methods And ResultsIn the Swedish Heart Failure Registry, HFmrEF (EF=40%-49%) and HFpEF (EF≥50%) patients reporting at least 2 consecutive outpatient NT-proBNP assessments were prospectively studied. Associations between reduction in NT-proBNP and overall mortality, HF hospitalization, and their composite were assessed by multivariable Cox regressions, with NT-proBNP changes modeled as binary (decrease/increase) or quantitative predictor by restricted cubic splines. In 650 patients, at a median of 7 months between the 2 measurements of NT-proBNP and over a median follow-up of 1.65 years, 361 patients (55%) showed a reduction and 289 patients (45%) an increase in NT-proBNP. Change in NT-proBNP was associated with risk of outcomes. Fifty-seven patients (16%) who decreased their NT-proBNP versus 78 patients (27%) who increased it died from any cause (adjusted hazard ratio=0.53; 95% confidence interval=0.36-0.77), 61 (17%) versus 86 (30%) were hospitalized for HF (hazard ratio=0.41; 95% confidence interval=0.29-0.60), and 96 (27%) versus 125 (43%) reported the composite outcome (hazard ratio=0.46; 95% confidence interval=0.34-0.62). These findings were replicated in HFmrEF and HFpEF separately.ConclusionsIn HFmrEF and HFpEF during routine care, decreases in NT-proBNP were associated with improved mortality and morbidity. Studies to determine whether NT-proBNP changes in response to therapy predict drug efficacy are needed.© 2016 American Heart Association, Inc.

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