USA: Findings from the EMPEROR-Reduced trial showed higher baseline NT-proBNP concentrations to be associated with poor cardiorenal outcomes. However, the use of empagliflozin reduced this risk across all NT-proBNP levels. The study appears in the Journal of the American College of Cardiology.
James L. Januzzi, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA, and colleagues sought to evaluate the relationship between N-terminal pro–B-type natriuretic peptide (NT-proBNP) and empagliflozin effects in EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction).
The study included patients with heart failure with reduced ejection fraction (HFrEF). They were randomly assigned to placebo or empagliflozin 10 mg daily. NT-proBNP was measured at baseline, 4 weeks, 12 weeks, 52 weeks, and 100 weeks. Patients were divided into quartiles of baseline NT-proBNP.
Following were the study findings:
Incidence rates for each study outcome were 4- to 6-fold higher among those in the highest versus lowest NT-proBNP quartiles (≥3,480 vs <1,115 pg/mL).
Study participants with higher NT-proBNP had 2- to 3-fold total hospitalizations higher than the lowest NT-proBNP quartile.
Empagliflozin reduced risk for major cardiorenal events without heterogeneity across NT-proBNP quartiles.
Empagliflozin treatment significantly reduced NT-proBNP at all timepoints examined; by 52 weeks, the adjusted mean difference from placebo was 13%.
An NT-proBNP in the lowest quartile (<1,115 pg/mL) 12 weeks after randomization was associated with lower risk for subsequent cardiovascular death or heart failure hospitalization regardless of baseline concentration.
Treatment with empagliflozin resulted in 27% higher adjusted odds of an NT-proBNP concentration of <1,115 pg/mL by 12 weeks compared with placebo.
"Among patients in the EMPEROR-Reduced Trial, treatment with empagliflozin reduced risk for CV and renal endpoints similarly across NT-proBNP concentrations, including among the patients at highest risk with most elevated baseline NT-proBNP concentration," wrote the authors.
The researchers concldued," The NT-proBNP concentration after treatment with empagliflozin better informs subsequent prognosis than pretreatment concentrations."
Reference:
The study titled, "Prognostic Importance of NT-proBNP and Effect of Empagliflozin in the EMPEROR-Reduced Trial," is published in the Journal of the American College of Cardiology.
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2021.07.046