Management of Chronic Heart Failure Guided by Individual N-Terminal Pro–B-Type Natriuretic Peptide Targets

Eurlings, Luc W.; Pol, P.E.J. van; Kok, Wouter E.; Wijk, Sandra van; Bolt, Cara L. B. Lodewijks-van der; Balk, A. H. M. M.; Lok, Dirk J.; Crijns, Harry J.G.M.; Kraaij, D.J.W. van; Jonge, Nicolaas de; Meeder, Joan G.; Prins, Martin H.; Pinto, Yigal M.

doi:10.1016/j.jacc.2010.07.030

Cited by 169 publications

(85 citation statements)

References 19 publications

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“…is prototypical. The PRIMA study by Eurlings et al 213 enrolled 345 patients and targeted discharge NT-proBNP after HF hospitalization or the observed lowest NT-proBNP in the 2 weeks after hospitalization. This more "individualized" approach was intended to minimize overtitration of therapies in patients with persistently elevated NT-proBNP.…”

Section: Neutral Biomarker-guided Hf Trialsmentioning

confidence: 99%

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Chow¹,

Maisel²,

et al. 2017

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Background and Purpose: Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. Methods: The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. Results: A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. Conclusions: HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their concentrations in blood not only can provide the clinician information about the diagnosis and severity of HF but also can improve prognostication and treatment strategies.

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Section: Neutral Biomarker-guided Hf Trialsmentioning

confidence: 99%

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Chow¹,

Maisel²,

et al. 2017

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“…In some studies, a prespecified treatment escalation algorithm was followed21, 22 while in other studies the attending clinician was instructed to escalate treatment according to their individual clinical judgment 23, 24, 25. Our study used an empirical prespecified treatment escalation strategy that, included increasing existing doses of furosemide followed by introduction of thiazide diuretics and spironolactone, similar to the algorithms described in the aforementioned human studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of prespecified therapy escalation on plasma NT‐proBNP concentrations in dogs with stable congestive heart failure due to myxomatous mitral valve disease

Hezzell

Block

Laughlin

et al. 2018

Veterinary Internal Medicne

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BackgroundTreatment targeted to achieve reduction in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) improves outcomes in human congestive heart failure (CHF) patients.HypothesisA pre‐specified therapeutic algorithm that increased diuretic or pimobendan usage will reduce plasma NT‐proBNP concentrations in dogs with CHF secondary to myxomatous mitral valve disease (MMVD).AnimalsTwenty‐six dogs with clinically stable CHF secondary to MMVD.MethodsProspective, controlled before‐and‐after study. Dogs were examined up to 3 times over 21 days. Treatment was prescribed based on NT‐proBNP as follows: <1500 pmol/L at baseline, no treatment adjustment at any point during the study (group 1); ≥1500 pmol/L and creatinine ≤3.0 mg/dL at baseline or SC visits, treatment escalated according to the algorithm (group 2); ≥1500 pmol/L at baseline, no treatment adjustment (group 3).ResultsN‐terminal pro‐B‐type natriuretic peptide decreased significantly in group 2 (mean change = −1736 pmol/L (95% CI, −804 to −2668), P < .001) but not in groups 1 or 3 (623 pmol/L [–631 to 1877 pmol/L], P = .14 and 685 pmol/L [–304 to 1068 pmol/L], P = .46, respectively). Serum BUN and creatinine did not change significantly between visit 0 and visit 2 in group 1 (median = 23 mg/dL [range 13‐32] versus 19 mg/dL [12‐38], P = .72 and 1.15 mg/dL [0.70‐1.40] versus 0.95 mg/dL [0.70‐1.10], P = .10, respectively) or group 2 (28 mg/dL [18‐87] versus 43.5 mg/dL [21‐160], P = .092 and 1.10 mg/dL [0.90‐2.50] versus 1.55 mg/dL [0.90‐3.30], P = .062, respectively).Conclusions and Clinical ImportanceUse of this treatment escalation algorithm allows effective targeting of treatment for CHF in dogs against an objective criterion.

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“…Elevated MMP‐9 levels may help identify patients at risk before an increase occurs in ventricular pressure overload, which reflects ongoing ventricular remodeling. The value of BNP levels for guiding therapy in addition to clinical symptom‐based treatment seems to be limited,9, 10, 11, 21 despite the undisputed diagnostic and prognostic importance of these values 6, 7, 8. The benefits of predicting HF events may be offset by non‐HF events.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, elevated plasma concentrations of brain natriuretic peptide (BNP) show notable associations with development of left ventricular dysfunction and HF 5. Although elevated BNP concentrations have diagnostic and prognostic importance,6, 7, 8 whether intense therapy for HF guided by BNP values is superior to therapy guided by clinical symptoms is unclear 9, 10, 11. BNP play important roles in maintaining cardiorenal homeostasis under physiological and pathological conditions.…”

Section: Introductionmentioning

confidence: 99%

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

et al. 2017

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AimsMatrix metalloproteinase (MMP) is up‐regulated during heart failure (HF) and influences ventricular remodeling. We hypothesized that disparity between MMP‐9 and tissue inhibitors of MMP‐1 (TIMP‐1) results in clinical manifestations and is related to prognostic risk in patients with chronic HF.Methods and resultsPlasma levels of MMP‐9, TIMP‐1, and brain natriuretic peptide (BNP) were measured in 173 patients with chronic HF. Combined endpoints of worsening HF events were assessed during follow‐up (median 109 months). MMP‐9 and TIMP‐1 levels and the MMP‐9/TIMP‐1 ratio increased with increasing severity of the New York Heart Association class (P for trend = 0.003, 0.011, and 0.005, respectively). Patients with HF events (n = 35) had significantly higher MMP‐9 than those without HF events (P = 0.004). Kaplan–Meier analysis demonstrated a higher probability of HF events with high MMP‐9 values (>23.2 ng/mL; P = 0.005). A multivariate Cox proportional hazard model showed that high MMP‐9 values were an independent predictor of HF events (hazard ratio, 3.73; 95% confidence interval (CI), 1.03–13.46; P = 0.043). In patients with lower BNP levels (≤210 pg/mL), the adjusted hazard ratio for HF events was 3.63 (95% CI, 1.20–11.02; P = 0.023) among patients with high MMP‐9 values compared with patients with low BNP and low MMP‐9 values.ConclusionsMMP‐9 and TIMP‐1 levels correlate with the severity of chronic HF. MMP‐9 is a strong predictor of HF events, suggesting that a disparity between MMP‐9 and TIMP‐1 levels and increased MMP‐9 levels may help predict HF events.

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Management of Chronic Heart Failure Guided by Individual N-Terminal Pro–B-Type Natriuretic Peptide Targets

Cited by 169 publications

References 19 publications

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Effect of prespecified therapy escalation on plasma NT‐proBNP concentrations in dogs with stable congestive heart failure due to myxomatous mitral valve disease

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

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