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Longitudinal evaluation of ventricular ejection fraction and NT-proBNP across heart failure subgroups

Martinsson, Andreas LU ; Oest, Petter; Wiborg, Maj Britt; Reitan, Öyvind LU and Smith, J. Gustav LU (2018) In Scandinavian Cardiovascular Journal 52(4). p.205-210
Abstract

Objectives: Left ventricular ejection fraction (EF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are important surrogate markers of cardiac function and wall stress. Randomized trials of heart failure (HF) have shown improvements in survival in patients with reduced EF (<40%, HFrEF) but not with preserved EF (≥50%, HFpEF) or mid-range EF (40-49%, HFmrEF). Limited information is available on the trajectory of EF in contemporary heart failure management programs (HFMPs). Design: 201 HF patients consecutively enrolled 2010–2011 in the outpatient-based HFMP of Skåne University Hospital in Lund were included in the study. Probable etiology, EF, NT-proBNP and medications were assessed at baseline and 1 year after enrollment.... (More)

Objectives: Left ventricular ejection fraction (EF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are important surrogate markers of cardiac function and wall stress. Randomized trials of heart failure (HF) have shown improvements in survival in patients with reduced EF (<40%, HFrEF) but not with preserved EF (≥50%, HFpEF) or mid-range EF (40-49%, HFmrEF). Limited information is available on the trajectory of EF in contemporary heart failure management programs (HFMPs). Design: 201 HF patients consecutively enrolled 2010–2011 in the outpatient-based HFMP of Skåne University Hospital in Lund were included in the study. Probable etiology, EF, NT-proBNP and medications were assessed at baseline and 1 year after enrollment. Results: HFrEF was the most common heart failure subgroup (78.1% of patients) in this HFMP, followed by HFmrEF (14.9%) and HFpEF (7.0%). The most common etiology was ischemic heart disease (IHD, 40.8%). Complete recovery of EF (>50%) was rare (14.1% of patients with HFrEF and 26.7% with HFmrEF), some degree of improvement was observed in 57.7% and 46.7% of patients. LVEF improved on average 9.1% in patients with HFrEF (p < .001) and NT-proBNP decreased from 4,202 to 2,030 pg/ml (p < .001). A similar trend was noticed for the HFmrEF group but was not statistically significant. The improvement in LVEF was consistent across subgroups with HF attributable to IHD (6.2%), idiopathic dilated cardiomyopathy (7.1%) and tachycardia-induced HF (17.5%). Conclusions: This study provides estimates of the improvement in LVEF and NT-proBNP that can be expected with contemporary management across subgroups of HF and different etiologies in a contemporary HFMP.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ejection fraction, Heart failure, heart failure management program, heart failure therapy, NT-proBNP
in
Scandinavian Cardiovascular Journal
volume
52
issue
4
pages
205 - 210
publisher
Taylor & Francis
external identifiers
  • scopus:85045258267
ISSN
1401-7431
DOI
10.1080/14017431.2018.1461920
language
English
LU publication?
yes
id
01a01704-2b87-41a7-bc8b-e18e06715e24
date added to LUP
2018-04-26 15:38:40
date last changed
2019-10-08 03:28:04
@article{01a01704-2b87-41a7-bc8b-e18e06715e24,
  abstract     = {<p>Objectives: Left ventricular ejection fraction (EF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are important surrogate markers of cardiac function and wall stress. Randomized trials of heart failure (HF) have shown improvements in survival in patients with reduced EF (&lt;40%, HFrEF) but not with preserved EF (≥50%, HFpEF) or mid-range EF (40-49%, HFmrEF). Limited information is available on the trajectory of EF in contemporary heart failure management programs (HFMPs). Design: 201 HF patients consecutively enrolled 2010–2011 in the outpatient-based HFMP of Skåne University Hospital in Lund were included in the study. Probable etiology, EF, NT-proBNP and medications were assessed at baseline and 1 year after enrollment. Results: HFrEF was the most common heart failure subgroup (78.1% of patients) in this HFMP, followed by HFmrEF (14.9%) and HFpEF (7.0%). The most common etiology was ischemic heart disease (IHD, 40.8%). Complete recovery of EF (&gt;50%) was rare (14.1% of patients with HFrEF and 26.7% with HFmrEF), some degree of improvement was observed in 57.7% and 46.7% of patients. LVEF improved on average 9.1% in patients with HFrEF (p &lt; .001) and NT-proBNP decreased from 4,202 to 2,030 pg/ml (p &lt; .001). A similar trend was noticed for the HFmrEF group but was not statistically significant. The improvement in LVEF was consistent across subgroups with HF attributable to IHD (6.2%), idiopathic dilated cardiomyopathy (7.1%) and tachycardia-induced HF (17.5%). Conclusions: This study provides estimates of the improvement in LVEF and NT-proBNP that can be expected with contemporary management across subgroups of HF and different etiologies in a contemporary HFMP.</p>},
  author       = {Martinsson, Andreas and Oest, Petter and Wiborg, Maj Britt and Reitan, Öyvind and Smith, J. Gustav},
  issn         = {1401-7431},
  keyword      = {ejection fraction,Heart failure,heart failure management program,heart failure therapy,NT-proBNP},
  language     = {eng},
  month        = {04},
  number       = {4},
  pages        = {205--210},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Cardiovascular Journal},
  title        = {Longitudinal evaluation of ventricular ejection fraction and NT-proBNP across heart failure subgroups},
  url          = {http://dx.doi.org/10.1080/14017431.2018.1461920},
  volume       = {52},
  year         = {2018},
}