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J Am Coll Cardiol, 2007; 49:1733-1739, doi:10.1016/j.jacc.2006.10.081 (Published online 30 March 2007).
© 2007 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Plasma Brain Natriuretic Peptide-Guided Therapy to Improve Outcome in Heart Failure

The STARS-BNP Multicenter Study

Patrick Jourdain, MD*,{dagger},{ddagger},*, Guillaume Jondeau, MD, PhD§, François Funck, MD{ddagger}, Pascal Gueffet, MD||, Alain Le Helloco, MD, Erwan Donal, MD, Jean F. Aupetit, MD#, Marie C. Aumont, MD§, Michel Galinier, MD, PhD**, Jean C. Eicher, MD{dagger}{dagger}, Alain Cohen-Solal, MD, PhD{ddagger}{ddagger} and Yves Juillière, MD, PhD§§

* René Descartes University, Paris, France
{dagger} Georges Pompidou Hospital, Paris, France
§ Department of Cardiology, Bichat University Hospital, Paris, France
{ddagger}{ddagger} Department of Cardiology, Centre Hospitalier Universitaire de Lariboisière, Paris, France
{ddagger} Hospitalier de Rene Dubos, Pontoise, France
|| Centre Hospitalier Universitaire de Nantes, Nantes, France
Centre Hospitalier Universitaire de Rennes, Rennes, France
# Hopital Saint Luc Lyon, Lyon, France
** Department of Cardiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
{dagger}{dagger} Centre Hospitalier Universitaire de Dijon, Dijon, France
§§ Department of Cardiology, Centre Hospitalier Universitaire de Vandoeuvre Les Nancy, Vandoeuvre Les Nancy, France.

Manuscript received September 12, 2006; revised manuscript received October 10, 2006, accepted October 22, 2006.

* Reprint requests and correspondence: Dr. Patrick Jourdain, Hopital de Pontoise, CH Rene Dubos, Heart Failure Department, 6 Avenue de France, Pontoise, 95301 France. (Email: patrick.jourdain{at}ch-pontoise.fr).

Objectives: The aim of this multicenter study was to evaluate the prognostic impact of a therapeutic strategy using plasma brain natriuretic peptide (BNP) levels.

Background: The prognosis of chronic heart failure (CHF) remains poor, even among patients treated in specialized departments.

Methods: A total of 220 New York Heart Association functional class II to III patients considered optimally treated with angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, and diuretics by CHF specialists were randomized to medical treatment according to either current guidelines (clinical group) or a goal of decreasing BNP plasma levels <100 pg/ml (BNP group). Outpatient visits were scheduled every month for 3 months, then every 3 months. The primary combined end point was CHF-related death or hospital stay for CHF.

Results: Both groups were similar for baseline clinical and biological characteristics. Left ventricular ejection fraction was slightly lower in the BNP group than in the clinical group (29.9 ± 7.7% vs. 31.8 ± 8.4%, p = 0.05). At the end of the first 3 months, all types of drugs were changed more frequently in the BNP group. Mean dosages of ACEIs and beta-blockers were significantly higher in the BNP group (p < 0.05), whereas the mean increase in furosemide dosage was similar in both groups. During follow-up (median 15 months), significantly fewer patients reached the combined end point in the BNP group (24% vs. 52%, p < 0.001).

Conclusions: In optimally treated CHF patients, a BNP-guided strategy reduced the risk of CHF-related death or hospital stay for CHF. The result was mainly obtained through an increase in ACEI and beta-blocker dosages.

Abbreviations and Acronyms
  ACEI = angiotensin-converting enzyme inhibitor
  ARB = angiotensin II-receptor blockers
  BNP = brain natriuretic peptide
  CHF = chronic heart failure
  LVEF = left ventricular ejection fraction
  NYHA = New York Heart Association




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