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Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model
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Biomarker-Guided Versus Clinically Guided Management Strategies for Heart Failure: A Systematic Review and

Hao Zhou1,2, Ting Liu1,2, Fuxia Lan1,2

  • 1Department of Cardiology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.

Reviews in Cardiovascular Medicine
|April 2, 2026
PubMed

Insights

Biomarker-guided therapy for heart failure (HF) showed a trend toward reduced mortality and hospitalizations, but evidence quality is low. Further high-quality trials are needed to confirm benefits and guide clinical practice.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Biomarker Research

Background:

  • The clinical utility of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy in heart failure (HF) management is debated.
  • Existing evidence from randomized controlled trials (RCTs) requires synthesis to clarify its impact on patient outcomes.

Purpose of the Study:

  • To conduct a meta-analysis of RCTs evaluating biomarker-guided HF therapy versus clinically guided management.
  • To determine if biomarker-guided strategies reduce all-cause mortality and HF-related hospitalizations.

Main Methods:

  • Systematic literature search of major databases (PubMed, Embase, Cochrane, Web of Science) up to May 2025.
  • Meta-analysis of 17 RCTs (5069 patients) using random-effects models.
  • Performed subgroup, sensitivity, and trial sequential analyses (TSA) to assess evidence robustness and potential bias.

Main Results:

  • Initial meta-analysis indicated significant reductions in all-cause mortality (RR 0.84) and HF hospitalizations (RR 0.79) with biomarker-guided therapy.
  • Sensitivity analysis excluding low-risk-of-bias studies rendered mortality benefit non-significant.
  • Potential publication bias was detected (Egger's test, p=0.0285), and TSA suggested insufficient cumulative evidence.

Conclusions:

  • The quality of evidence for biomarker-guided HF therapy is rated as 'very low' (GRADE assessment).
  • Methodological limitations in primary studies and potential publication bias compromise findings.
  • Current evidence is insufficient to support routine clinical use; large-scale, high-quality RCTs are necessary.
Abstract

Keywords:
biomarkersbrain natriuretic peptideheart failuremeta-analysissystematic review

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