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

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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

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Acknowledgements

The authors appreciate John McMurrary (University of Glasgow) for his insightful advice regarding study design and the interpretation of study results.

Funding

None.

Author information

Author notes

  1. Chan Soon Park and Jin Joo Park contributed equally to this work.

Authors and Affiliations

  1. Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea

    Chan Soon Park

  2. Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea

    Jin Joo Park & Dong-Ju Choi

  3. Department of Anesthesiology and Intensive Care Medicine, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, University Paris Diderot, UMR 942 Inserm, Paris, France

    Alexandre Mebazaa

  4. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Hae-Young Lee

  5. Heart Research Center, Chonnam National University, Gwangju, Republic of Korea

    Kye Hun Kim

  6. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

    Byung-Su Yoo

  7. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seok-Min Kang

  8. Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Sang Hong Baek

  9. Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea

    Eun-Seok Jeon

  10. Division of Cardiology, Asan Medical Center, Seoul, Republic of Korea

    Jae-Joong Kim

  11. Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea

    Myeong-Chan Cho

  12. Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea

    Shung Chull Chae

  13. Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea

    Byung-Hee Oh

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  1. Chan Soon Park
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  2. Jin Joo Park
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Correspondence to Dong-Ju Choi.

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Park, C.S., Park, J.J., Mebazaa, A. et al. Response to beta-blockers and natriuretic peptide level in acute heart failure: analysis of data from the Korean acute heart failure registry. Clin Res Cardiol 110, 1392–1403 (2021). https://doi.org/10.1007/s00392-020-01689-8

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  • DOI: https://doi.org/10.1007/s00392-020-01689-8

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