BNP-Guided vs Symptom-Guided Heart Failure Therapy

Pfisterer, Matthias; Buser, Peter; Rickli, Hans; Gutmann, Marc; Erné, Paul; Rickenbacher, Peter; Vuillomenet, A.G.; Jeker, Urs; Dubach, Paul; Beer, Jürg H.; Yoon, Se‐Il; Suter, Thomas M.; Osterhues, H.-H.; Schieber, M.; Hilti, Patrick; Schindler, Ruth; Rocca, Hans‐Peter Brunner‐La; Investigators, for the TIME-CHF

doi:10.1001/jama.2009.2

Cited by 551 publications

(175 citation statements)

References 34 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…Several potential reasons may explain our observations. BNP‐guided therapy does not always improve clinical outcomes as previously reported 9, 10, 11. The reason for this lack of significant improvement may be that BNP levels only change upon ventricular wall stretching.…”

Section: Discussionmentioning

confidence: 70%

“…Elevated MMP‐9 levels may help identify patients at risk before an increase occurs in ventricular pressure overload, which reflects ongoing ventricular remodeling. The value of BNP levels for guiding therapy in addition to clinical symptom‐based treatment seems to be limited,9, 10, 11, 21 despite the undisputed diagnostic and prognostic importance of these values 6, 7, 8. The benefits of predicting HF events may be offset by non‐HF events.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, elevated plasma concentrations of brain natriuretic peptide (BNP) show notable associations with development of left ventricular dysfunction and HF 5. Although elevated BNP concentrations have diagnostic and prognostic importance,6, 7, 8 whether intense therapy for HF guided by BNP values is superior to therapy guided by clinical symptoms is unclear 9, 10, 11. BNP play important roles in maintaining cardiorenal homeostasis under physiological and pathological conditions.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

et al. 2017

View full text Add to dashboard Cite

AimsMatrix metalloproteinase (MMP) is up‐regulated during heart failure (HF) and influences ventricular remodeling. We hypothesized that disparity between MMP‐9 and tissue inhibitors of MMP‐1 (TIMP‐1) results in clinical manifestations and is related to prognostic risk in patients with chronic HF.Methods and resultsPlasma levels of MMP‐9, TIMP‐1, and brain natriuretic peptide (BNP) were measured in 173 patients with chronic HF. Combined endpoints of worsening HF events were assessed during follow‐up (median 109 months). MMP‐9 and TIMP‐1 levels and the MMP‐9/TIMP‐1 ratio increased with increasing severity of the New York Heart Association class (P for trend = 0.003, 0.011, and 0.005, respectively). Patients with HF events (n = 35) had significantly higher MMP‐9 than those without HF events (P = 0.004). Kaplan–Meier analysis demonstrated a higher probability of HF events with high MMP‐9 values (>23.2 ng/mL; P = 0.005). A multivariate Cox proportional hazard model showed that high MMP‐9 values were an independent predictor of HF events (hazard ratio, 3.73; 95% confidence interval (CI), 1.03–13.46; P = 0.043). In patients with lower BNP levels (≤210 pg/mL), the adjusted hazard ratio for HF events was 3.63 (95% CI, 1.20–11.02; P = 0.023) among patients with high MMP‐9 values compared with patients with low BNP and low MMP‐9 values.ConclusionsMMP‐9 and TIMP‐1 levels correlate with the severity of chronic HF. MMP‐9 is a strong predictor of HF events, suggesting that a disparity between MMP‐9 and TIMP‐1 levels and increased MMP‐9 levels may help predict HF events.

show abstract

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Design11 and main results12 of TIME‐CHF have been published previously. In brief, TIME‐CHF was a randomized, controlled multicenter trial comparing an N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP)‐guided vs a symptom‐guided management strategy in patients with chronic HF aged ≥60 years with symptoms corresponding to New York Heart Association (NYHA) ≥II, HF‐related hospitalization within 12 months prior to inclusion, and an age‐adjusted elevated NT‐proBNP plasma concentration (>400 ng/L in those <75 years, >800 ng/L in those ≥75 years).…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, we have prospectively measured ∆HR in patients with chronic HF included in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME‐CHF)11, 12 to describe the association of ∆HR with clinical characteristics in an elderly HF cohort and to evaluate its prognostic value.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure

Maeder

Zurek

Rickli

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundThe prognostic value of the change in heart rate from the supine to upright position (∆HR) in patients with chronic heart failure (HF) is unknown.Methods and Results∆HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME‐CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆HR on 18‐month outcome (HF hospitalization‐free survival) was assessed. In addition, the prognostic effect of changes in ∆HR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ∆HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI} 1.19‐2.75] if ∆HR ≤3 beats/min [bpm], P=0.004). In the multivariate analysis, lower ∆HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18‐2.61] if ∆HR ≤3 bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β‐blocker use. In patients without event during the first 6 months, the change in ∆HR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12–5.00] if rise in ∆HR <2 bpm; P=0.027).Conclusions∆HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. ∆HR is modifiable, and changes in ∆HR also provide prognostic information, which raises the possibility that ∆HR may help to guide treatment.Clinical Trial Registration Information URL: www.isrctn.org. Unique identifier: ISRCTN43596477.

show abstract

B-Type Natriuretic Peptide–Guided Heart Failure Therapy

et al. 2010

View full text Add to dashboard Cite

B-type natriuretic peptide-guided therapy reduces all-cause mortality in patients with chronic HF compared with usual clinical care, especially in patients younger than 75 years. A component of this survival benefit may be due to increased use of agents proven to decrease mortality in chronic HF. However, there does not seem to be a reduction in all-cause hospitalization or an increase in survival free of hospitalization using this approach.

show abstract

BNP-Guided vs Symptom-Guided Heart Failure Therapy

Cited by 551 publications

References 34 publications

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure

B-Type Natriuretic Peptide–Guided Heart Failure Therapy

Contact Info

Product

Resources

About