Page 72 - Biomarkers for risk stratification and guidance in heart failure

Management of chronic heart failure guided by individual NT-proBNP targets.
overview of trials—including recent metaanalyses—suggests that BNP- or NTproBNP-guided therapy may reduce mortality, especially in younger patients.
Thus, it may have a role as an adjunct to standard of care, especially in younger
patients, particularly those with systolic dysfunction. Second, the PRIMA study
highlights the potential limitations of using an individualized target NT-proBNP
level. Use of a single target level of BNP or NT-proBNP, perhaps adjusted for
clinical covariates such as age,7,27 appears to offer the best opportunity for the biomarker-guided strategy to alter management. As is the case for their use
as diagnostic markers, changes in serial BNP and NT-proBNP levels should be 3 interpreted within the entire clinical context, including reference to other tests,
such as those for renal function.
Finally, further data are needed from more robust, adequately powered trials
with hard clinical outcomes and from a meta-analysis utilizing individual patient data (rather than summary grouped data) before guidelines can confidently endorse a biomarker-guided strategy. Recent studies, including biomarker-guided studies, have highlighted the lack of efficacy of medical therapy in heart failure with preserved systolic function and more particularly in elderly patients.5,7,28 Whether the biomarker-guided strategy is applicable to elderly patients and those with heart failure and preserved left ventricular ejection fraction remains unclear and needs further evaluation.
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