Will the therapy of chronic heart failure be guided by plasma levels of natriuretic peptides?


Authors: J. Hradec;  J. Krupička;  T. Janota
Authors‘ workplace: Univerzita Karlova v Praze, 1. lékařská fakulta, III. interní klinika VFN
Published in: Čas. Lék. čes. 2009; 148: 383-388
Category: Review Article

Overview

Natriuretic peptides, especially BNP and NT-proBNP became useful tool for both, the diagnostics and the estimation of prognosis in chronic heart failure. As the plasma levels of natriuretic peptides copy changes in clinical status, an attractive hypothesis was formed saying that BNP/NT-proBNP guided therapy could have better clinical outcomes than therapy guided by patients’ clinical status (symptoms). In past few years this hypothesis was tested in several randomized controlled clinical trials (STARS-BNP, TIME-CHF, PRIMA). However, results of these trials are very controversial.

There are preliminary results of clinical trial OPTIMA referred in this paper, too. This one-centre study was performed at the authors’ institution. Altogether 52 patients with chronic heart failure were randomized to one of the above mentioned treatment strategies. The rate of cardiovascular events was lower in the patients in whom the treatment was guided by BNP values compared to the patients in whom the treatment was guided by their clinical status. However, the difference was not statistically significant.

Key words:
BNP/NT-proBNP, chronic heart failure, BNP-guided treatment, OPTIMA study.


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