Cardiac Biomarkers Response Under Angiotensin Receptor-Neprilysin Inhibitor: A Sub-Analysis of the Natrium-HF Study.
Publisher DOI
PubMed ID
41834516
Abstract
Aims
Natriuretic peptides (NPs) are central to the diagnostic and therapeutic management of heart failure (HF), yet their short-term dynamics under sacubitril/valsartan (S/V) therapy and during acute volume changes remain incompletely characterized. We aimed to assess changes in circulating biomarkers and response to standardized acute intravascular volume expansion and diuretic treatment before and after S/V initiation.Methods
We studied 229 ambulatory patients with HF with reduced ejection fraction receiving guideline-directed medical therapy who initiated S/V. Patients were evaluated at three outpatient visits: before S/V initiation and after 2 and 3 months of treatment. At each visit, participants underwent a standardized 9-hour protocol including volume infusion followed by diuretic administration. BNP, NT-proBNP, MR-proANP and neprilysin activity were measured serially alongside clinical assessment and natriuresis.Results
Across visits, initiation of S/V was associated with lower concentrations of BNP (-8%, p = 0.009) and NT-proBNP (-35%, p < 0.001). During the acute protocol, both BNP and NT-proBNP increased significantly over time (timepoint effect p < 0.001), with parallel trajectories before and after S/V initiation and no visit-by-time interaction (p = 0.17 for BNP; p = 0.95 for NT-proBNP). Despite marked natriuresis and improvement in clinical signs following diuretic administration, BNP and NT-proBNP continued to rise during the 9-hour observation period.Conclusion
In a controlled acute volume overload setting, BNP and NT-proBNP provide comparable information, but their short-term dynamics lag behind clinical decongestion. Routine serial NP measurements at very short time intervals are unlikely to add incremental clinical value in the early phase of acute HF.
Natriuretic peptides (NPs) are central to the diagnostic and therapeutic management of heart failure (HF), yet their short-term dynamics under sacubitril/valsartan (S/V) therapy and during acute volume changes remain incompletely characterized. We aimed to assess changes in circulating biomarkers and response to standardized acute intravascular volume expansion and diuretic treatment before and after S/V initiation.Methods
We studied 229 ambulatory patients with HF with reduced ejection fraction receiving guideline-directed medical therapy who initiated S/V. Patients were evaluated at three outpatient visits: before S/V initiation and after 2 and 3 months of treatment. At each visit, participants underwent a standardized 9-hour protocol including volume infusion followed by diuretic administration. BNP, NT-proBNP, MR-proANP and neprilysin activity were measured serially alongside clinical assessment and natriuresis.Results
Across visits, initiation of S/V was associated with lower concentrations of BNP (-8%, p = 0.009) and NT-proBNP (-35%, p < 0.001). During the acute protocol, both BNP and NT-proBNP increased significantly over time (timepoint effect p < 0.001), with parallel trajectories before and after S/V initiation and no visit-by-time interaction (p = 0.17 for BNP; p = 0.95 for NT-proBNP). Despite marked natriuresis and improvement in clinical signs following diuretic administration, BNP and NT-proBNP continued to rise during the 9-hour observation period.Conclusion
In a controlled acute volume overload setting, BNP and NT-proBNP provide comparable information, but their short-term dynamics lag behind clinical decongestion. Routine serial NP measurements at very short time intervals are unlikely to add incremental clinical value in the early phase of acute HF.
Date Issued
2026-03-03
Publication Type
Article
Subject(s)
Subjects
angiotensin receptor-neprilysin inhibitor
•
heart failure
•
natriuretic peptides
•
neprilysin
•
volume overload
Language(s)
en
Author(s)
Daghmouri, Aziz | |
Sadoune, Malha | |
Lafontaine, Romane | |
Nguyen, Alexis | |
Edwards, Christopher | |
Davison, Beth | |
Cotter, Gad | |
Takagi, Koji | |
Varounis, Christos | |
Morishetty, Priyanka | |
Azibani, Feriel | |
Masson, Elisabeth | |
Chenevier-Gobeaux, Camille | |
Mebazaa, Alexandre | |
Deniau, Benjamin |
Additional Credits
Journal
ESC Heart Failure
Publisher
Oxford University Press
ISSN
2055-5822
Access(Rights)
open.access