Physicians' Academy for Cardiovascular Education

Levels of natriuretic peptides related to therapeutic effect and CV outcomes in HFpEF patients

Interaction Between Spironolactone and Natriuretic Peptides in Patients With Heart Failure and Preserved Ejection Fraction

From the TOPCAT Trial

Literature - Anand IS, Claggett B, Liu J, et al. - JACC, 2017;5(4):241-252

Main results

Conclusion

Using either continuous NP values or NP values grouped by tertiles, NP values were independently associated with an increased risk for the composite of cardiovascular death, HF hospitalization and aborted cardiac arrest in HFpEF patients. This confirms previous findings that NPs are important prognostic markers in patients with HFpEF. In addition, there was a significant interaction between the effect of spironolactone and NP levels, with most of the beneficial effects seen in lower-risk patients with low NP levels, in contrast to high NP levels. This suggests that patients at higher risk are not always more likely to benefit from treatment. Thus, the strategy of using elevated plasma concentrations of NPs as a patient selection criterion in trials of HFpEF needs to be re-examined in prospectively designed clinical trials.

References

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