Introduction on Biomarker Guided Therapy in Chronic Heart Failure
Although the first study on biomarker-guided therapy of chronic heart failure (HF) was published 15 years ago,1 there is still no real proof of the superiority of this approach as compared with standard therapy. The guidelines of the European Society of Cardiology simply state that: “several RCTs that evaluated natriuretic peptide-guided treatment (intensifying treatment in order to lower peptide levels) have given conflicting results. It is uncertain whether outcome is better using this approach than by simply optimising treatment according to guidelines”. Apart from being markers of function of different organs, biomarkers, mainly natriuretic peptides, are considered useful only for excluding HF and as prognostic markers.2 However, several metaanalyses,3–6 including a very recent one based on individual patientdata (IPD),7 have found that natriuretic peptide-guided therapy may reduce both mortality and HF related hospitalisations. However, one recent systematic review was less positive and concluded that current evidence does not support the use of B-type naturiuretic peptide (BNP) and N-terminal pro (NT-pro)BNP. to guide HF therapy.8 This review addresses current evidence of natriuretic peptide-guided therapy and discusses potential reasons why this approach needs further investigation. Moreover, it will give short insight into other emerging biomarkers that are promising for therapy guidance in chronic HF.