Prognostic Importance of BNP (B-type natriuretic peptide) and Effect of Empagliflozin in the EMPEROR-Reduced Trial
Among patients affected by heart failure (HF) with reduced ejection fraction (HFrEF), elevated concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with more severe symptoms, worse health status, and a higher risk for hospitalization for HF or cardiovascular (CV) death (1)
- showed that with respect to the application of guideline directed medical therapy (GDMT)
- in patients with HFrEF, those with decrease in NT-proBNP <=1000 pg/mL during GDMT had better outcomes
In a pre-specified analysis using data of the EMPEROR-Reduced trial, it was examined (2):
- whether baseline NT-proBNP had an effect on the efficacy of SGLT2 inhibitors in HFrEF
- what the effect of SGLT2 inhibitors was on levels of NT-proBNP,
- whether changes in NT-proBNP after SGLT2i treatment were associated with subsequent outcomes
Study results (2):
- treatment with empagliflozin reduced time to first events of CV death, hospitalization or the composite of both events across NT-proBNP quartiles without interaction with baseline NT-proBNP (P trend >0.05)
- use of empagliflozin reduced the risk of total hospitalizations for HF in all NT-proBNP quartiles, with no heterogeneity between groups (Ptrend=0.49). Similar results were seen for all-cause mortality
- patients had a lower risk of the primary endpoint of CV death/HF hospitalization if they had NT-proBNP of <1,115 pg/mL at week 12, regardless of baseline value of NT-proBNP
- in an adjusted model, treatment with empagliflozin resulted in a 27% (95%CI: 5.6-52.6) higher likelihood of having NT-proBNP of <1,115 pg/mL (P=0.01).
- in those with an NT-proBNP of >= 1,115 pg/mL at baseline, treatment with empagliflozin resulted in an adjusted 35% (95CI: 17-56) higher likelihood of achieving an NT-proBNP of <1,115 pg/mL compared to the placebo group (P<0.001)
The study authors concluded (2):
- in EMPEROR-Reduced, higher baseline NT-proBNP concentrations were associated with greater risk for adverse heart failure or renal outcomes, but empagliflozin reduced risk regardless of baseline NT-proBNP concentration
- the NT-proBNP concentration after treatment with empagliflozin better informs subsequent prognosis than pretreatment concentrations
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