Saremi Adonis, Gopal Dipika, Maisel Alan S
UCSD Medical Center, Department of Internal Medicine, University of California-San Diego, 200 W. Arbor Dr., San Diego, CA 92103, USA.
Expert Rev Cardiovasc Ther. 2012 Feb;10(2):191-203. doi: 10.1586/erc.11.188.
Heart failure is extremely prevalent and is associated with significant mortality, morbidity and cost. Studies have already established mortality benefit with the use of neurohormonal blockade therapy in systolic failure. Unfortunately, physical signs and symptoms of heart failure lack diagnostic sensitivity and specificity, and medication doses proven to improve mortality in clinical trials are often not achieved. Brain natriuretic peptide (BNP) has proven to be of clinical use in the diagnosis and prognosis of heart failure, and recent efforts have been taken to further elucidate its role in guiding heart failure management. Multiple studies have been conducted on outpatient guided management, and although still controversial, there is a trend towards improved outcomes. Inpatient studies are lacking, but preliminary data suggest various BNP cut-off values, as well as percentage changes in BNP, that could be useful in predicting outcomes and improving mortality. In the future, heart failure management will probably involve an algorithm using clinical assessment and a multibiomarker-guided approach.
心力衰竭极为常见，且与高死亡率、高发病率及高额费用相关。研究已证实，在收缩性心力衰竭中使用神经激素阻断疗法可带来死亡率获益。遗憾的是，心力衰竭的体征和症状缺乏诊断敏感性和特异性，而在临床试验中已证实能改善死亡率的药物剂量往往难以达到。脑钠肽（BNP）已被证明在心力衰竭的诊断和预后评估中具有临床应用价值，并且最近已开展进一步研究以阐明其在指导心力衰竭管理中的作用。针对门诊指导管理已开展了多项研究，尽管仍存在争议，但有改善预后的趋势。住院患者研究较少，但初步数据表明，各种BNP临界值以及BNP的百分比变化可能有助于预测预后和降低死亡率。未来，心力衰竭管理可能会采用一种结合临床评估和多生物标志物指导方法的算法。
