Response to beta-blockers and natriuretic peptide level in acute heart failure: analysis of data from the Korean acute heart failure registry

Chan Soon Park, Jin Joo Park, Alexandre Mebazaa, Hae Young Lee, Kye Hun Kim, Byung Su Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

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Abstract

Background: To investigate the effect of beta-blockers according to NP levels and HF phenotypes because natriuretic peptide (NP) level can be used to risk-stratify HF patients regardless of left ventricular ejection fraction (LVEF). Methods: Of 5,625 patients in the Korean acute heart failure registry, we included patients with LVEF and NP levels. HF phenotypes were defined as HF with reduced ejection fraction (HFrEF) (EF ≤ 40%), HF with midrange ejection fraction (HFmrEF) (40% < EF < 50%), and HF with preserved EF (HFpEF) (EF ≥ 50%). Patients were further stratified by NP tertiles. Primary outcome was 5-year all-cause mortality according to beta-blocker use at discharge. Results: Both B-type NP (BNP) (r = −0.279, P < 0.001) and N-terminal pro-BNP (r = −0.186, P < 0.001) levels correlated inversely with LVEF. During a median follow-up duration of 961 days, 1560 (35.3%) patients died. In HFrEF, patients taking beta-blockers showed better survival regardless of NP levels. Regarding HFmrEF, there was no mortality difference between those taking and not taking beta-blockers. In HFpEF, beta-blocker use demonstrated lower mortality in those in the 3rd NP tertile (log-rank P = 0.041) but not in those in the 1st and 2nd NP tertiles (log-rank P > 0.05). After adjusting covariates, the use of beta-blockers was associated with a 38%-reduced mortality (hazard ratio: 0.62; 95% confidence interval: 0.39–0.98; P = 0.040) in HFpEF patients in the 3rd NP tertile but not in those in 1st and 2nd tertiles. Conclusions: We confirm that the use of beta-blockers is beneficial in patients with HFrEF. Furthermore, we extend the benefits of beta-blockers to patients with HFpEF and high NP levels. Clinical Trial Registration: ClinicalTrial.gov identifier: NCT01389843 URL: https://clinicaltrials.gov/ct2/show/NCT01389843 Graphic abstract: [Figure not available: see fulltext.].

Original languageEnglish
JournalClinical Research in Cardiology
DOIs
Publication statusAccepted/In press - 2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Park, C. S., Park, J. J., Mebazaa, A., Lee, H. Y., Kim, K. H., Yoo, B. S., Kang, S. M., Baek, S. H., Jeon, E. S., Kim, J. J., Cho, M. C., Chae, S. C., Oh, B. H., & Choi, D. J. (Accepted/In press). Response to beta-blockers and natriuretic peptide level in acute heart failure: analysis of data from the Korean acute heart failure registry. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-020-01689-8