Dr Januzzi: NT-proBNP changes from minute to minute, from hour to hour. The studies that have shown improvement in NT-proBNP but no improvement in clinical endpoints were studies that gave a short -term treatment. For example, Levosimendan (calcium sensitizer) given for a week, shows the NT-proBNP decrease, but then the endpoints were a month later or six months later. The problem is that an early change in NT-proBNP if you stop the therapy is not going to predict outcomes a month or six months later. You need an NT-proBNP at that same time point in order to say that it is or it is not predictive. So early changes in NT-proBNP only matter if you keep the therapy going eg Levosimendan. There were data from the ATMOSPHERE trial, looking at Aliskiren (direct Renin inhibitor) that showed small reductions in NT-proBNP. Small reductions are associated with small benefits. In reduced EF heart failure, the NT-proBNP changes are quite predictive.
