title: Use of biomarkers to guide outpatient therapy of heart failure.
abstract: OBJECTIVE
  Among patients with heart failure, concentrations of natriuretic peptides are strongly linked to the presence and severity of structural heart disease and are strongly prognostic in this setting. Additionally, favorable reduction in the concentration of either B-type natriuretic peptide (BNP) or B-type natriuretic peptide and its amino-terminal cleavage fragment (NT-proBNP) may be seen during treatment of heart failure, with parallel improvement in prognosis. This has led to the hypothesis that intensified treatment directed at reducing natriuretic peptide concentrations may improve outcomes in heart failure.
  
  
  RESULTS
  In chronic heart failure, studies suggest that a strategy of standard-of-care management together with a goal to suppress BNP or NT-proBNP concentrations leads to greater application of guideline-derived medical therapy and is well tolerated. In certain studies of this BNP or NT-proBNP 'guided' approach, patients treated with biomarker-guided care had superior outcomes when compared with standard heart failure management alone, particularly in younger study populations, in patients with left ventricular systolic dysfunction, and particularly when substantial reductions in natriuretic peptides were achieved in association with biomarker-guided care.
  
  
  CONCLUSIONS
  Natriuretic peptide 'guided' management appears promising in patients suffering from chronic heart failure. Large-scale pivotal trials to confirm the approach are planned.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Benedetta
authors.initials: B
authors.lastname: DeBeradinis
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D054316:Biomarkers, Pharmacological; D006333:Heart Failure / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D020097:Natriuretic Peptide, Brain; D010045:Outpatients; D010446:Peptide Fragments; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D054316:Biomarkers, Pharmacological; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain