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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.
Heart International
|February 6, 2023
Summary
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.
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