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Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?
Med Univ Innsbruck, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0002-5795-0061
Heidelberg Univ, Med Klin 3, Heidelberg, Germany..
Wilhelminen Hosp, Dept Med Cardiol & Intens Care Med, Vienna, Austria..
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2017 (English)In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 6, no 4, p. 321-328Article in journal (Refereed) Published
Abstract [en]

Since the approval of sacubitril-valsartan for the treatment of chronic heart failure with reduced ejection fraction, a commonly raised suspicion is that a wider clinical use of this new drug may diminish the clinical utility of B-type natriuretic peptide testing as sacubitril may interfere with B-type natriuretic peptide clearance. In this education paper we critically assess this hypothesis based on the pathophysiology of the natriuretic peptide system and the limited published data on the effects of neprilysin inhibition on natriuretic peptide plasma concentrations in humans. As the main clinical application of B-type natriuretic peptide testing in acute cardiac care is and will be the rapid rule-out of suspected acute heart failure there is no significant impairment to be expected for B-type natriuretic peptide testing in the acute setting. However, monitoring of chronic heart failure patients on sacubitril-valsartan treatment with B-type natriuretic peptide testing may be impaired. In contrast to N-terminal-proBNP, the current concept that the lower the B-type natriuretic peptide result in chronic heart failure patients, the better the prognosis during treatment monitoring, may no longer be true.

Place, publisher, year, edition, pages
2017. Vol. 6, no 4, p. 321-328
Keywords [en]
Sacubitril-valsartan, natriuretic peptides, B-type natriuretic peptide, diagnosis, heart failure, acute cardiac care
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-329722DOI: 10.1177/2048872615626355ISI: 000403461700004PubMedID: 26758541OAI: oai:DiVA.org:uu-329722DiVA, id: diva2:1143608
Available from: 2017-09-21 Created: 2017-09-21 Last updated: 2017-09-21Bibliographically approved

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