Natriuretic peptide-guided management in heart failure

Ovidiu Chioncel*, Sean P. Collins, Stephen J. Greene, Andrew P. Ambrosy, Muthiah Vaduganathan, Cezar MacArie, Javed Butler, Mihai Gheorghiade

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

Abstract

Heart failure is a clinical syndrome that manifests from various cardiac and noncardiac abnormalities. Accordingly, rapid and readily accessible methods for diagnosis and risk stratification are invaluable for providing clinical care, deciding allocation of scare resources, and designing selection criteria for clinical trials. Natriuretic peptides represent one of the most important diagnostic and prognostic tools available for the care of heart failure patients. Natriuretic peptide testing has the distinct advantage of objectivity, reproducibility, and widespread availability. The concept of tailoring heart failure management to achieve a target value of natriuretic peptides has been tested in various clinical trials and may be considered as an effective method for longitudinal biomonitoring and guiding escalation of heart failure therapies with overall favorable results. Although heart failure trials support efficacy and safety of natriuretic peptide-guided therapy as compared with usual care, the relationship between natriuretic peptide trajectory and clinical benefit has not been uniform across the trials, and certain subgroups have not shown robust benefit. Furthermore, the precise natriuretic peptide value ranges and time intervals of testing are still under investigation. If natriuretic peptides fail to decrease following intensification of therapy, further work is needed to clarify the optimal pharmacologic approach. Despite decreasing natriuretic peptide levels, some patients may present with other highrisk features (e.g. elevated troponin). A multimarker panel investigating multiple pathological processes will likely be an optimal alternative, but this will require prospective validation. Future research will be needed to clarify the type and magnitude of the target natriuretic peptide therapeutic response, as well as the duration of natriuretic peptideguided therapy in heart failure patients.

Original languageEnglish (US)
Pages (from-to)556-568
Number of pages13
JournalJournal of Cardiovascular Medicine
Volume17
Issue number8
DOIs
StatePublished - Aug 1 2016

Keywords

  • Heart failure
  • management
  • natriuretic peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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