title: Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?
abstract: 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.
authors.affiliation: 1 Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mair
authors.affiliation: 2 Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: 3 Medizinische Klinik III, University of Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: 4 Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: 5 Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thygesen
authors.affiliation: 6 Department of Laboratory Medicine, University Hospital Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.affiliation: 7 Division of Emergency Medicine and Department of Cardiology, Charité- Universitätsmedizin Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.affiliation: 8 Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: 9 Mayo Clinic and Medical School, USA.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000613:Aminobutyrates / Q000009:adverse effects* / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D001713:Biphenyl Compounds; D002908:Chronic Disease; D004338:Drug Combinations; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000187:drug effects* / Q000378:metabolism; D045265:Natriuretic Peptides / Q000097:blood / Q000502:physiology*; D015260:Neprilysin / Q000037:antagonists & inhibitors*; D010446:Peptide Fragments / Q000187:drug effects; D011237:Predictive Value of Tests; D013318:Stroke Volume / Q000187:drug effects; D013777:Tetrazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D004338:Drug Combinations; D045265:Natriuretic Peptides; D010446:Peptide Fragments; D013777:Tetrazoles; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000068756:Valsartan; D015260:Neprilysin; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: B-type natriuretic peptide; Sacubitril-valsartan; acute cardiac care; diagnosis; heart failure; natriuretic peptides