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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^_*,,,_*, Guillaume Jondeau, MD, PhD, François Funck, MD, 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, Alain Cohen-Solal, MD, PhD and Yves Juillière, MD, PhD

^_* René Descartes University, Paris, France
Georges Pompidou Hospital, Paris, France
Department of Cardiology, Bichat University Hospital, Paris, France
Department of Cardiology, Centre Hospitalier Universitaire de Lariboisière, Paris, France
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
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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