Abstract
Up to now, monitoring of chronic heart failure essentially is refined to serial assessment of NYHA functional class and echocardiographically measured parameters such as left ventricular ejection fraction. The B-type natriuretic peptide (BNP) and the N-terminal fragment of its prohormone (NT-proBNP) reflect myocardial wall stress and are associated with the severity and prognosis of heart failure. In recent years, several controlled trials investigated the value of these natriuretic peptides in monitoring the clinical course and optimizing the pharmacological treatment of patients with heart failure. Metaanalyses suggest that a natriuretic peptide guided strategy may decrease the mortality risk in patients below the age of 75 years. By contrast, effects on cardiovascular or heart failure related hospitalisation were inconclusive. Thus, BNP and NT-proBNP may be used to monitor the clinical course of patients with chronic heart failure. However, the utility of a natriuretic peptide guided approach to improve the individual course of disease under real-world conditions is still unclear. Larger trials with less selected patient populations and longer follow-up time are needed to pursue this topic.
Literatur
-
1
Iwanaga Y, Nishi I, Furuchi S et al.
B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure.
J Am Coll Cardiol.
2006;
47
742-748
-
2
Haass M.
Biomarker bei Herzinsuffizienz.
Kardiologie up2date.
2005;
1
23-40
-
3 Haass M. Kardiale Marker bei Herzinsuffizienz.. In: Haass M, Giannitsis E, Katus H A, (Hrsg) Diagnostische Marker in der Kardiologie. 2. Aufl. Uni-Med; Bremen; 2011: 1-36
-
4
Johnson W, Omland T, Hall C et al.
Neurohumoral activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure.
J Am Coll Cardiol.
2002;
39
1623-1629
-
5
Maeda K, Tsutamoto T, Wada A et al.
High levels of brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure.
J Am Coll Cardiol.
2000;
36
1587-1593
-
6
Kasama S, Toyama T, Hatori T et al.
Comparative effects of valsartan and enalapril on cardiac sympathetic nerve activity and plasma brain natriuretic peptide in patients with congestive heart failure.
Heart.
2006;
92
625-630
-
7
Anand I S, Fisher L D, Chiang Y T et al.
Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial.
Circulation.
2003;
107
1278-1283
-
8
Felker G M, Hasselblad V, Hernandez A F, O’Connor C M.
Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials.
Am Heart J.
2009;
158
422-430
-
9
Porapakkham P, Porapakkham P, Zimmet H et al.
B-Type natriuretic peptide-guided heart failure therapy – A meta-analysis.
Arch Intern Med.
2010;
170
507-514
-
10
O’Donoghue M, Braunwald E.
Natriuretic peptides in heart failure: should therapy be guided by BNP levels?.
Nat Rev.
2010;
7
13-20
-
11
Richards A M, Troughton R W.
Use of natriuretic peptides to guide and monitor heart failure therapy.
Clin Chem.
2012;
58
62-71
-
12
Motwani J G, McAlpine H, Kennedy N, Struthers A D.
Plasma brain natriuretic peptide as an indicator for angiotensin-converting-enzyme inhibition after myocardial infarction.
Lancet.
1993;
341
1109-1113
-
13
Tsutamoto T, Wada A, Maeda K et al.
Effects of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure.
J Am Coll Cardiol.
2001;
37
1228-1233
-
14
Davis M E, Richards A M, Nicholls M G et al.
Introduction of metoprolol increases plasma B-type cardiac natriuretic peptides in mild, stable heart failure.
Circulation.
2006;
113
977-985
-
15
Sliwa K, Norton D R, Korne N et al.
Impact of initiating carvedilol before angiotensin-converting enzyme inhibitor therapy on cardiac function in newly diagnosed heart failure.
J Am Coll Cardiol.
2004;
44
1825-1830
-
16
Zugck C, Haunstetter A, Krüger C et al.
Impact of beta-blocker treatment on the prognostic value of currently used risk predictors in congestive heart failure.
J Am Coll Cardiol.
2002;
39
1615-1622
-
17
Fruhwald F M, Fahrleitner-Pammer A, Berger R et al.
Early and sustained effects of cardiac resynchronization therapy on N-terminal pro-B-type natriuretic peptides in patients with moderate to severe heart failure and cardiac dyssynchrony.
Eur Heart J.
2007;
28
1592-1597
-
18
Troughton R W, Frampton C M, Yandle T G et al.
Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations.
Lancet.
2000;
355
1126-1130
-
19
Jourdain P, Jondeau G, Funck F et al.
Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure – The STARS-BNP multicenter study.
J Am Coll Cardiol.
2007;
49
1733-1739
-
20
Shah M R, Califf R M, Nohria A et al.
The STARBRITE trial: a randomized, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure.
J Card Fail.
2011;
17
613-621
-
21
Pfisterer M, Buser P, Rickli H, Gutmann M et al.
BNP-guided vs symptom-guided heart failure therapy – The trial of intensified vs. standard medical therapy in elderly patients with congestive heart failure (TIME-CHF) randomized trial.
JAMA.
2009;
301
383-392
-
22
Lainchbury J G, Troughton R W, Strangman K M et al.
N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmission and Death) trial.
J Am Coll Cardiol.
2009;
55
53-60
-
23
Eurlings L W, van Pol P E, Kok W E et al.
Management of chronic heart failure guided by individual N-terminal pro-B-type natriuretic peptide targets: results of the PRIMA (Can Pro-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) study.
J Am Coll Cardiol.
2010;
56
2090-2100
-
24
Berger R, Moertl D, Peter S et al.
N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure.
J Am Coll Cardiol.
2010;
55
645-653
-
25
Persson H, Erntell H, Eriksson B et al.
Improved pharmacological therapy of chronic heart failure in primary care: a randomized Study of NT-proBNP guided management of heart failure – SIGNAL-HF (Swedish Intervention study – Guidelines and NT-proBNP AnaLysis in Heart Failure).
Eur Heart J.
2010;
12
1300-1308
-
26
Dickstein K, Cohen-Solal A, Filippatos G et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESCIM).
Eur J Heart Fail.
2008;
10
933-989
-
27
Hoppe U E, Böhm M, Dietz R et al.
Leitlinien zur Therapie der chronischen Herzinsuffizienz.
Z Kardiol.
2005;
94
488-509
-
28
Hoppe U E, Böhm M, Drexler H et al.
Kommentar zu den ESC-Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 – Leitlinien zur Therapie der chronischen und akuten Herzinsuffizienz: Was ist neu?.
Kardiologe.
2008;
3
16-23
-
29 Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften et al. Nationale Versorgungsleitlinie Herzinsuffizienz. 2009 Im Internet: http://www.versorgungsleitlinien.de/themen/herzinsuffizienz Stand: 6.2.2012
Prof. Dr. med. Markus Haass
Innere Medizin II (Kardiologie, Angiologie und Internistische Intensivmedizin)
Theresienkrankenhaus
Bassermannstr. 1
68165 Mannheim
Email: m.haass@theresienkrankenhaus.de
Prof. Dr. med. Stefan Störk
Deutsches Zentrum für Herzinsuffizienz Würzburg
Universitätsklinikum und Universität Würzburg
Straubmühlweg 2a
97078 Würzburg
Email: stoerk_s@klinik.uni-wuerzburg.de
