Prognostic Impact of Sustained Reduction of N-Terminal Pro-B-Type Natriuretic Peptide After Initiating Sacubitril/Valsartan - Insights From the REVIEW-HF Registry.

Background: Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) values after initiating sacubitril/valsartan (Sac/Val) are considered a favorable prognostic factor in patients with heart failure (HF). However the relationship between the trajectory of repeated NT-proBNP measurements and cardiovascular events after Sac/Val remains uncertain.

Methods and results: A Japanese nationwide multicenter study enrolled 995 patients who were prescribed Sac/Val from August 2020 to August 2021. Of them, 434 patients who had a complete set of NT-proBNP measurements were divided into 3 groups: sustained-responder group (n=129), with ≥10% reduction in NT-proBNP at 1 month and further ≥10% reduction at 3 months; transient-responder group (n=161), with ≥10% reduction at 1 month but not at 3 months; and non-responder group (n=144), without ≥10% reduction at 1 month. There were no significant differences in the mean Sac/Val dose at each measurement point among the 3 groups. During a median follow-up of 456 (interquartile range: 371-549) days, the primary endpoint, which was either cardiovascular death or hospitalization for HF, occurred in 78 patients. Kaplan-Meier analysis revealed that the sustained-responder group had a significantly higher event-free survival rate among the 3 groups (Log-rank P<0.001).

Conclusions: Repeated NT-proBNP monitoring and the pattern of the NT-proBNP trajectory after Sac/Val may be helpful in optimizing HF therapy and understanding the prognosis of HF.