Quantifying Heart Failure Using Natriuretic Peptides May Help the HEART Teamin Decision-making

Eleni Michou; Gregor Fahrni; Christian Mueller

Disclosures

Eur Heart J. 2019;40(41):3406-3408. 

In This Article

What are the Next Steps?

Substantial work is still necessary for the safe and effective implementation of BNP and NT-proBNP concentrations in this novel indication in clinical practice. First, large external validation studies need to confirm the interaction between the presence and extent of HF quantified by BNP and NT-proBNP concentrations and the relative benefits of PCI vs. CABG. Secondly, the Chinese study employed a less widely used NT-proBNP assay.[4] Future studies need to define the optimal cut-off concentrations for the more widely used NT-proBNP assays. Thirdly, BNP and NT-proBNP concentrations may on one hand be possible indicators of long-term benefit from CABG, but on the other hand are also predictors of peri-operative mortality. Therefore, the association between the extent of HF and the benefit from CABG is unlikely to be linear.

In summary, the evidence for the implementation of BNP or NT-proBNP concentrations into the HEART team decision kit obviously is not as strong as that of the SS and diabetes mellitus. However, it is at least comparable with that of most other variables used for decision-making in patients with three-vessel CAD. Considering that these tests constitute a well-established aid for clinicians in cardiovascular medicine and in several clinical settings, feasibility of their implementation should be high.[8]

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