Ibrahim Nasrien E, Januzzi James L
Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, GRB-800, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
Curr Heart Fail Rep. 2018 Apr;15(2):37-43. doi: 10.1007/s11897-018-0381-0.
Biomarker-guided management of patients with chronic heart failure with reduced ejection fraction (HFrEF) remains controversial.
Biomarkers have established roles for diagnosis and prognostication in HF. Pilot data suggested that use of natriuretic peptides might be helpful to guide HF care. The recent Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) randomized-controlled trial did not find therapy guided by NT-proBNP to be more effective than usual care in improving the primary endpoint of HF hospitalization or cardiovascular mortality amongst patients with chronic HFrEF. Patients in GUIDE-IT received similar care and had similar NT-proBNP lowering regardless of treatment allocation. Though biomarkers retain important standing for diagnosis and prognosis in HF, the GUIDE-IT trial results suggest carefully managed patients may not benefit from a biomarker-guided strategy. Future studies focusing this intervention on patients treated in a more real-world setting are needed.
对于射血分数降低的慢性心力衰竭（HFrEF）患者，生物标志物指导下的管理仍存在争议。
生物标志物在心力衰竭的诊断和预后评估中已确立了作用。初步数据表明，使用利钠肽可能有助于指导心力衰竭的治疗。最近的心力衰竭生物标志物强化治疗指导循证治疗（GUIDE-IT）随机对照试验未发现，在改善慢性HFrEF患者的心力衰竭住院或心血管死亡这一主要终点方面，由NT-proBNP指导的治疗比常规治疗更有效。无论治疗分配如何，GUIDE-IT试验中的患者接受了相似的治疗，且NT-proBNP降低程度相似。尽管生物标志物在心力衰竭的诊断和预后评估中仍具有重要地位，但GUIDE-IT试验结果表明，经过精心管理的患者可能无法从生物标志物指导的策略中获益。未来需要针对在更真实临床环境中接受治疗的患者开展聚焦于这种干预措施的研究。
