NT-proBNP and ICD in Nonischemic Systolic Heart Failure: Extended Follow-Up of the DANISH Trial

Jawad H. Butt*, Adelina Yafasova, Marie B. Elming, Ulrik Dixen, Jens C. Nielsen, Jens Haarbo, Lars Videbæk, Eva Korup, Niels E. Bruun, Hans Eiskjær, Axel Brandes, Anna M. Thøgersen, Finn Gustafsson, Kenneth Egstrup, Christian Hassager, Jesper Hastrup Svendsen, Dan E. Høfsten, Christian Torp-Pedersen, Steen Pehrson, Jens Jakob ThuneLars Køber

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

4 Citations (Scopus)

Abstract

Objectives: In this extended follow-up study of the DANISH (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality) trial, adding 4 years of additional follow-up, we examined the effect of implantable cardioverter-defibrillator (ICD) implantation according to baseline N-terminal pro–B-type natriuretic peptide (NT-proBNP) level. Background: In the DANISH trial, NT-proBNP level at baseline appeared to modify the response to ICD implantation. Methods: In the DANISH trial, 1,116 patients with nonischemic systolic HF were randomized to receive an ICD (N = 556) or usual clinical care (N = 550). Outcomes were analyzed according to NT-proBNP levels (below/above median) at baseline. The primary outcome was death from any cause. Results: All 1,116 patients in the DANISH trial had an available NT-proBNP measurement at baseline (median: 1,177 pg/mL; range: 200-22,918 pg/mL). There was a trend toward a reduction in all-cause death with ICD implantation, compared with usual clinical care, in patients with NT-proBNP levels lower than the median (HR: 0.75 [95% CI: 0.55-1.03]), but not in those with higher NT-proBNP levels (HR: 0.95 [95% CI: 0.74-1.21]) (Pinteraction = 0.28). Similarly, ICD implantation significantly reduced the rate of cardiovascular (CV) and sudden cardiovascular death (SCD) in patients with NT-proBNP levels lower than the median (CV death, HR: 0.69 [95% CI: 0.47-1.00]; SCD, HR: 0.37 [95% CI: 0.19-0.75]), but not in those with higher levels (CV death, HR: 0.94 [95% CI: 0.70-1.25]; SCD, HR: 0.86 [95% CI: 0.49-1.51]) (Pinteraction = 0.20 and 0.08 for CV death and SCD, respectively). Conclusions: Lower baseline NT-proBNP levels could identify patients with nonischemic systolic HF who may derive benefit from ICD implantation. (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality [DANISH]; NCT00542945)

Original languageEnglish
JournalJACC. Heart failure
Volume10
Issue number3
Pages (from-to)161-171
Number of pages11
ISSN2213-1779
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Publisher Copyright:
© 2022 American College of Cardiology Foundation

Keywords

  • heart failure
  • implantable cardioverter-defibrillator
  • mortality
  • N-terminal pro–B-type natriuretic peptide

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