Prognostic value of BNP in heart failure with preserved or reduced ejection fraction
Résumé
Heart failure (HF) is a growing concern for the public healthcare, especially among elderly patients where diagnosis, treatment and prevention of re-hospitalisation are challenging. HF with preserved EF (HFpEF) incidence has steadily increased over time without significant improvement in treatment and survival. Natriuretic peptides (NP), including B-type NP (BNP) and N-terminal-proBNP (NT-proBNP), are primarily upregulated by increased atrial or ventricular diastolic wall stress and have emerged as powerful predictors of adverse cardiovascular outcomes (death or hospitalisation) in patients with HF, which had mainly been demonstrated in HF with reduced EF (HFrEF). Consequently, European Society of Cardiology (ESC) guidelines published in 2012 have incorporated BNP as a tool for diagnosis and prognosis (class of recommendation IIa, level C). American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines proposed these biomarkers for guided HF therapy in selected patients (class IIa, level B). These recommendations are also considering that evidence of BNP-guided management in HF to reduce mortality or hospitalisation rates is insufficient for being used systematically (class IIb, level B). Thus, NP might help clinician but does not seem to provide robust enough information to be strongly recommended. New approaches like combination with biomarkers like ST21 or imaging tools such as echocardiography would have to be considered.