Natriuretic Peptides in Chronic Heart Failure

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Measurement of natriuretic peptides (NP) is well established in the diagnostic process of heart failure (HF). It is particularly helpful for exclusion of HF, both in acute decompensation and in the outpatient setting. Still, levels of NPs are influenced by many factors other than HF. It is important to understand these factors for more accurate interpretation of the results. NPs have strong prognostic power, but the question is how this influences clinical practice. On the one hand, some studies used NPs as inclusion criterium and should therefore be considered. On the other hand, various studies investigated the role of NPs to guide therapy in the chronic setting. Results are conflicting and the most recent and largest study (GUIDE-IT) was neutral. The conflicting results are due to significant differences between trials. Importantly, effects in HFrEF and HFpEF are different. If only considering HFrEF studies in chronic HF, meta-analysis shows a survival benefit of app. 20% by using NP guidance of HF therapy. Finally, the new drug sacubitril may influence levels of NPs and this effect is smallest for NT-proBNP. This webinar discusses the clinical value of NPs in the setting of (chronic) HF and where measurement of NPs is useful.


Hans-Peter Brunner-La Rocca

Hans-Peter Brunner-La Rocca

Key Learning Objectives

  • What is the clinical use of measuring natriuretic peptide for diagnosis of heart failure in different setting?
  • How can the results of natriuretic peptides in the acute and chronic setting of heart failure be interpreted?
  • What is the influence of sacubitril/valsartan on natriuretic peptide levels?
  • Should the interpretation of the values be changed?
  • What is the clinical value of the strong prognostic value of natriuretic peptides in heart failure?
  • What are the characteristics and the differences between the studies investigating therapy guidance by BNP and NT-proBNP?
  • How should results of the (NT-pro)BNP-guidance therapy studies in chronic heart failure be interpreted and how do these results impact the treatment of heart failure?
  • What do we learn from these studies?
  • What do we learn from these studies?

Target Audience

  • General cardiology
  • Heart failure specialists
  • Heart failure nurses
  • General practitioners
  • Internal medicine

Faculty Biographies

Hans-Peter Brunner-La Rocca

Hans-Peter Brunner-La Rocca

Hans-Peter Brunner-La Rocca is a heart failure cardiologist, trained in Switzerland and has been working in the Academic Hospital Maastricht, in the Netherlands for 10 years. He is head of the Heart Failure Clinic and head of the division of Structural Heart Diseases. His main research interests are biomarkers and eHealth to achieve personalised treatment in heart failure. He was the trial leader of the TIME-CHF study. He has published >200 scientific articles in the field and is a renowned expert in clinical biomarker research.

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Key References

1. Brunner-La Rocca HP, Sanders-van Wijk S. Natriuretic Peptides in Chronic Heart Failure. Card Fail Rev. 2019 Feb;5(1):44-49. doi: 10.15420/cfr.2018.26.1. PMID: 30847245

2. Taylor KS, Verbakel JY, Feakins BG, et al. Diagnostic accuracy of point-of-care natriuretic peptide testing for chronic heart failure in ambulatory care: systematic review and meta-analysis. BMJ 2018;361:k1450. doi.org/10.1136/bmj.k1450; PMID: 29785952.

3. Mair J, Lindahl B, Giannitsis E, et al. Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care? Eur Heart J Acute Cardiovasc Care. 2017 Jun;6(4):321-328. doi: 10.1177/2048872615626355. PMID: 26758541

4. Brunner-La Rocca HP, Eurlings L, Richards AM, et al. Which heart failure patients profit from natriuretic peptide guided therapy? A meta-analysis from individual patient data of randomized trials. Eur J Heart Fail. 2015 Dec;17(12):1252-61. doi: 10.1002/ejhf.401. PMID: 26419999

5. Roberts E, Ludman AJ, Dworzynski K, et al. The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ. 2015 Mar 4;350:h910. doi: 10.1136/bmj.h910. PMID: 25740799

6. Sanders-van Wijk S, van Asselt AD, Rickli H, et al. Cost-effectiveness of N-terminal pro-B-type natriuretic-guided therapy in elderly heart failure patients: results from TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure). JACC Heart Fail. 2013 Feb;1(1):64-71. doi: 10.1016/j.jchf.2012.08.002. PMID: 24621800

7. Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA. 2013 Jul 3;310(1):66-74. doi: 10.1001/jama.2013.7588. PMID: 23821090

8. Hildebrandt P, Collinson PO, Doughty RN, et al. Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care. Eur Heart J. 2010 Aug;31(15):1881-9. doi: 10.1093/eurheartj/ehq163. PMID: 20519241

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