Prognostic Implications of Changes in N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Heart Failure

Abstract

Patients who attained a significant reduction in NT-proBNP had a lower subsequent rate of cardiovascular death or HF hospitalization independent of the treatment group. Treatment with sacubitril/valsartan was nearly twice as likely as enalapril to reduce NT-proBNP to values ≤1,000 pg/ml. (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) [PARADIGM-HF]; NCT01035255.).

A prospective, randomized, double‐blind, placebo‐controlled pilot study of sacubitril/valsartan (Entresto) in dogs with cardiomegaly secondary to myxomatous mitral valve disease

“…Sacubitril/valsartan is 2 times more likely to cause a clinically meaningful decrease in NT‐proBNP concentrations compared to enalapril in humans, and this reduction has been shown to have a prognostic benefit in those taking S/V 24, 41. Sacubitril/valsartan prevents NP enzymatic degradation via NEP inhibition, leading to sustained concentrations of biologically active NPs.…”

“…Sacubitril/valsartan prevents NP enzymatic degradation via NEP inhibition, leading to sustained concentrations of biologically active NPs. Although BNP concentrations increase with S/V treatment, NT‐proBNP concentrations can decrease because NT‐proBNP is not a substrate for NEP degradation and is cleared by different mechanisms 41. Sacubitril/valsartan has been shown to decrease left atrial volume and dimensions in humans, improving hemodynamics and decressing the stimulus for NP release, which can lead to decreased BNP, and subsequently decreased NT‐proBNP, concentrations 42.…”

Serial measurements of natriuretic peptide to assess pharmacological interventions and subsequent impact on cardiovascular risk stratification in heart failure: a precision medicine approach

“…To conclude, Zile et al (11) indicate the beneficial application of serial measurements of NPs for improved prognostic qualities in HF risk management. The 1-month reduction in circulating levels of NT-proBNP was associated with improved outcome and that a contemporary drug, sacubitril/valsartan (LCZ-696), was able to improve this reduction in HF patients, thus suggesting an improvement in prognosis.…”

“…To extend upon these baseline measurements of NT-proBNP, the Val-HeFT trial also observed relationships between 4-month changes in circulating NP levels and associations with adverse outcome, showing the use of serial measurements of NT-proBNP for risk stratification in stable and chronic HF (9). Recently, Zile et al (11) investigated the use of repeated NT-proBNP measurements to assess how changes in circulating levels are associated with future adverse events, and whether these associations were influenced dependent on the medication treatment strategies employed, with a focus on the new drug; sacubitril/valsartan (LCZ-696). The study investigated 1,942 patients from the PARADIGM-HF [Prospective Comparison of ARNI (Angiotensin Receptor-Neprilysin Inhibitor) with ACEI (Angiotensin-Converting-Enzyme Inhibitor) to Determine Impact on Global Mortality and Morbidity in Heart Failure] trial with circulating NT-proBNP levels measured at baseline and 1 month later after treatment with sacubitril/valsartan (LCZ-696) or enalapril.…”

“…Clinically, studies such as that by Zile et al (11) indicate the increasing need to develop therapeutic strategies and risk calculations that are tailored and personalised to the patient with a focus on efficiency and precision. In PARADIGM-HF, the use of enalapril and LCZ-696 is focussed on the assessment of their ability to influence NP biology and their resultant effect on the dynamic processing of these cardiorenal protective peptides.…”