Di Tano Giuseppe, Clerico Aldo
U.O. Cardiologia, Ospedale di Cremona, ASST, Cremona.
Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa.
G Ital Cardiol (Rome). 2017 Feb;18(2):95-100. doi: 10.1714/2663.27294.
A large body of evidence supports the use of natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal proBNP [NT-proBNP]) for the evaluation and management of patients with heart failure over time. Elevated values reflect an enhanced counterregulatory response to hemodynamic stress and are indicative of heart failure severity, thus predicting prognosis. The clinical relevance and result interpretation of natriuretic peptides for monitoring therapy are still debated, and our understanding of their complex nature is still far from being complete. The new data about the clinical efficacy of LCZ696, a combination neprilysin inhibitor and angiotensin receptor blocker recently approved for the treatment of symptomatic chronic heart failure, showed a different susceptibility of BNP and NT-proBNP during therapy. The aim of this article is to discuss the controversial issues concerning the clinical use of cardiac natriuretic peptide measurement, the complex relationship with neprilysin pathways, and the practical implications of LCZ696 therapy for natriuretic peptide testing in clinical practice.
大量证据支持随着时间推移使用利钠肽（脑利钠肽[BNP]和N末端脑钠肽原[NT-proBNP]）来评估和管理心力衰竭患者。升高的值反映了对血流动力学应激的增强的反调节反应，并且指示心力衰竭的严重程度，从而预测预后。利钠肽在监测治疗中的临床相关性和结果解读仍存在争议，而且我们对其复杂性质的理解仍远未完整。关于LCZ696（一种最近被批准用于治疗有症状的慢性心力衰竭的新型组合药物，即中性内肽酶抑制剂和血管紧张素受体阻滞剂）临床疗效的新数据显示，治疗期间BNP和NT-proBNP的敏感性不同。本文的目的是讨论有关心脏利钠肽测量临床应用的争议性问题、与中性内肽酶途径的复杂关系以及LCZ696治疗在临床实践中对利钠肽检测的实际影响。
