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Natriuretic Peptide-guided Therapy for Heart Failure
Yu Horiuchi1, Humberto Villacorta2, Alan S Maisel3
1Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Chiyoda City, Kanda Izumicho, Japan.
Insights
Natriuretic peptide (NP)-guided therapy may benefit heart failure with reduced ejection fraction (HFrEF) patients, particularly those under 75. However, NP guidance shows no benefit in HF with preserved ejection fraction (HFpEF) or acute heart failure settings.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Trials
Background:
- Heart failure (HF) presents significant mortality and hospitalization challenges.
- Current HF management relies on clinical assessment, with natriuretic peptides (NPs) as key diagnostic and prognostic biomarkers.
- NPs, including B-type natriuretic peptide (BNP) and N-terminal proBNP, are crucial for HF diagnosis and prognosis, guiding therapy adjustments.
Purpose of the Study:
- To evaluate the efficacy of natriuretic peptide (NP)-guided therapy in managing heart failure (HF).
- To determine if NP-guided therapy improves outcomes in different HF subtypes and clinical settings.
- To assess the role of NP-guided therapy in preventing HF development.
Main Methods:
- Review of clinical trials investigating NP-guided therapy versus conventional care in HF patients.
- Analysis of outcomes including cardiac events, mortality, and HF progression across various HF populations.
- Stratification of results based on ejection fraction (HFrEF vs. HFpEF) and acute vs. chronic settings.
Main Results:
- NP-guided therapy showed potential benefits in heart failure with reduced ejection fraction (HFrEF), particularly reducing mortality in patients under 75 years.
- Conflicting results were observed in HFrEF studies (e.g., STARS-BNP, PROTECT, BATTLESCARRED, TIME-CHF vs. PRIMA, GUIDE-IT).
- No significant differences were found with NP-guided therapy in HF with preserved ejection fraction (HFpEF) or acute HF settings. NP guidance may aid in preventing HF in at-risk individuals.
Conclusions:
- NP-guided therapy appears beneficial for HFrEF patients, especially younger individuals (<75 years).
- NP-guided therapy is not effective in HFpEF or acute HF management.
- NPs can be valuable for guiding therapy and preventing HF in at-risk populations.
Abstract:
Heart failure (HF) is a complex syndrome with high mortality and hospitalization rates. Conventional care in patients with HF is usually based on clinical history and physical examination. Natriuretic peptides (NPs), B-type NP (BNP) and N-terminal proBNP, are the gold-standard biomarkers in HF. They are recommended for diagnosing HF, when the physician is uncertain of the diagnosis, and for estimating the prognosis. NPs also guide therapy in HF, as serial NP measurements inform medication adjustments to achieve targets independently of symptoms. In this regard, the data are conflicting. In patients with HF and reduced left ventricular ejection fraction (HFrEF) there is a suggestion that NP-guided therapy is helpful. The studies STARS-BNP and PROTECT demonstrated a reduction in cardiac events with NP-guided therapy. Additionally, mortality in patients aged <75 years reduced in the BATTLESCARRED and TIME-CHF studies, and in a meta-analysis. On the contrary, no differences were observed in the studies PRIMA and GUIDE-IT. In HF with preserved ejection fraction (HFpEF) and in the acute setting, no differences were detected with NP-guided therapy compared with conventional care. In patients at risk of developing HF, NP can be useful to guide therapy and prevent HF. In summary, NP-guided therapy seems to be useful in patients with HFrEF, especially in those aged <75 years, but has no use in HFpEF or in acute HF.
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