Abstract
BACKGROUND: N-terminal pro–B-type natriuretic peptide (NT-proBNP) concentrations serve as markers of prognosis and therapeutic response in patients with heart failure (HF). The effect of the non-steroidal MRA finerenone on NT-proBNP in patients with HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) is currently unknown. METHODS: The FINEARTS-HF trial randomized patients with HFmrEF/HFpEF and NT-proBNP ≥300 pg/ml (≥900pg/ml if atrial fibrillation) or BNP ≥100 pg/ml (≥300 pg/ml if atrial fibrillation) to finerenone vs placebo. Core laboratory NT-proBNP was measured at baseline, 3, and 12 months after randomization. We evaluated the association between log-transformed NT-proBNP and the primary outcome (cardiovascular death and total worsening HF events), whether baseline NT-proBNP modified the effect of finerenone on this outcome, and the effect of finerenone on NT-proBNP concentration. RESULTS: Baseline NT-proBNP was available in 5843 of 6001 patients analyzed (median 1041 [IQR 449,1946] pg/ml) and was strongly associated with risk of the primary outcome: adjusted rate ratio 1.44 per doubling in biomarker concentration (95% CI 1.37–1.51], P<0.001). Baseline NT-proBNP did not modify the benefit of finerenone on the primary outcome (P(interaction)=0.92). Finerenone reduced NT-proBNP by 12.1% (95% CI 8.5–15.4%) at 3 months and 12.5% (95% CI 8.1–16.7%) at 12 months, compared to placebo. CONCLUSIONS: In patients with HFmrEF/HFpEF, finerenone reduced NT-proBNP within months of initiation, and improved clinical outcomes regardless of baseline NT-proBNP concentration.