Association between NT-proBNP changes and clinical outcomes in paediatric patients with heart failure: Insights from PANORAMA-HF and PARADIGM-HF

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-05-12 DOI:10.1002/ehf2.15326

Robert Shaddy, Jianjian Gong, Tania Garito, Susan Solar-Yohay, Sijia Zhang, Margaret F. Prescott, Damien Bonnet, Paul F. Kantor, Michael Burch, Chad Mao, Antoinette Cilliers, Charles Canter, Yuk Law, Giorgia Grutter, Jou Kou Wang, Aamir Jeewa, Joseph Rossano, PANORAMA-HF investigators

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引用次数: 0

Abstract

Aims

The PANORAMA-HF trial demonstrated significant N-terminal pro-B-type natriuretic peptide (NT-proBNP) reductions in paediatric patients with left ventricular systolic dysfunction with sacubitril/valsartan or enalapril treatment over 52 weeks. This post hoc analysis aims to correlate changes in NT-proBNP levels with clinical outcomes in PANORAMA-HF patients receiving either sacubitril/valsartan or enalapril. Additionally, NT-proBNP reductions in the paediatric population were compared with a subset of adult heart failure with reduced ejection fraction (HFrEF) patients from the PARADIGM-HF trial.

Methods and results

This post hoc analysis utilized data from Part 2 of the PANORAMA-HF trial. Associations between baseline NT-proBNP levels, changes post-baseline and the risk of HF clinical events in paediatric patients on sacubitril/valsartan or enalapril were assessed. The paediatric HF population from PANORAMA-HF was categorized into age groups (AG): AG1 (aged 6 to <18 years), AG2a (aged 2 to <6 years) and AG3a (aged 1 month to <2 years). The Cox proportional hazard model evaluated the relationship between NT-proBNP and clinical outcomes. Analysis of 361 paediatric patients (sacubitril/valsartan, n = 179; enalapril, n = 182) demonstrated overall higher baseline NT-proBNP levels in younger AGs. At Week 52, both treatment groups exhibited reduced NT-proBNP levels across all AGs. Reductions were comparable between sacubitril/valsartan and enalapril, with a numerically greater reduction observed in adult patients versus children. Strong associations between NT-proBNP levels and HF clinical outcomes were observed in paediatric populations in PANORAMA-HF and in adult DCM patients with HFrEF in PARADIGM-HF. Doubling of NT-proBNP levels was associated with a ≥1.7-fold increased risk of HF clinical events, while halving of the levels correlated with a 52% reduction in the risk of clinical events.

Conclusions

This is the first prospective, randomized large-scale study to demonstrate a strong correlation between NT-proBNP levels and risks of HF clinical events in paediatric patients with HF.

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小儿心力衰竭患者NT-proBNP变化与临床结局的关系：来自PANORAMA-HF和PARADIGM-HF的见解

目的：PANORAMA-HF试验显示，在左心室收缩功能障碍的儿童患者中，使用苏比利/缬沙坦或依那普利治疗52周后，n端前b型利钠肽（NT-proBNP）显著降低。这项事后分析旨在将NT-proBNP水平的变化与接受苏比里尔/缬沙坦或依那普利治疗的PANORAMA-HF患者的临床结果联系起来。此外，在PARADIGM-HF试验中，儿科人群的NT-proBNP降低与成人心力衰竭伴射血分数降低（HFrEF）患者进行了比较。方法和结果：本事后分析利用了PANORAMA-HF试验第2部分的数据。评估了基线NT-proBNP水平、基线后变化与服用苏比里尔/缬沙坦或依那普利的儿科患者HF临床事件风险之间的关系。来自PANORAMA-HF的儿童HF人群被分为年龄组（AG）： AG1（6岁至）结论：这是第一个前瞻性，随机大规模研究，证明NT-proBNP水平与儿童HF患者HF临床事件风险之间存在很强的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.