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Targeting Natriuretic Peptide Levels in Heart Failure with Therapy: Does “X” Really Mark the Spot?

Current Heart Failure Reports volume 16, pages 250–256 (2019)Cite this article

Abstract

Purpose of Review

Explore controversial biomarker-guided management of patients with heart failure (HF) with reduced ejection fraction.

Recent Findings

Natriuretic peptides (e.g., BNP, NT-proBNP) are elevated in HF as a result of end-diastolic stress and are used in the diagnosis and prognosis of heart failure. Natriuretic peptide levels decrease with guideline-directed medical therapy (GDMT). Multiple small studies examined whether the use of biomarker-guided therapy would be beneficial to guide HF care and potentially improve outcomes. Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT), the largest randomized control study seeking to answer that question, did not find biomarker guided therapy to be more effective than usual care in improving the primary endpoints of HF hospitalization or cardiovascular mortality in HF patients.

Summary

Natriuretic peptides are important for diagnosis and prognosis in HF. GUIDE-IT showed that patients with HF and reduced ejection did not benefit from biomarker-guided strategy in terms of clinical outcomes. Future studies could focus on additional routine clinical care settings and take into account other HF phenotypes including preserved ejection fraction.

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Fig. 1

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Disclosures

JKL reports no relevant disclosures. RJM receives research support from the National Institutes of Health (U01HL125511-01A1 and R01AG045551-01A1), Akros, Amgen, AstraZeneca, Bayer, GlaxoSmithKline, Gilead, InnoLife, Luitpold/American Regent, Medtronic, Merck, Novartis, and Sanofi; honoraria from Abbott, Amgen, AstraZeneca, Bayer, Boston Scientific, Janssen, Luitpold Pharmaceuticals, Medtronic, Merck, Novartis, and Sanofi; and has served on an advisory board for Amgen, AstraZeneca, Luitpold, Merck, Novartis, and Boehringer Ingelheim.

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  1. Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Juliette K. Logan & Robert J. Mentz

  2. Duke Clinical Research Institute, PO Box 17969, Durham, NC, 27715, USA

    Robert J. Mentz

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Dr. Mentz reports grants and personal fees from Novartis, grants and personal fees from Amgen, grants and personal fees from AstraZeneca, grants and personal fees from Merck, grants and personal fees from Bayer, personal fees from Sanofi, grants from American Regent, grants from Medtronic, personal fees from Abbott, personal fees from Boehringer Ingelheim, during the conduct of the study.

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This article is part of the Topical Collection on Biomarkers of Heart Failure

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Logan, J.K., Mentz, R.J. Targeting Natriuretic Peptide Levels in Heart Failure with Therapy: Does “X” Really Mark the Spot?. Curr Heart Fail Rep 16, 250–256 (2019). https://doi.org/10.1007/s11897-019-00441-2

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Keywords

  • Heart failure
  • Biomarker
  • Natriuretic peptides
  • Guidelines
  • Heart failure therapy
  • Clinical trials