Gioli-Pereira Luciana, Katsuyama Eric Shih, Fukunaga Christian Ken, Falco Wilson, Padovese Camila Campos Grisa, Melo Rafael Hortencio, Melo Edielle de Sant'Anna, Ribeiro Papp Silvana E, Bacal Fernando
Department of Cardiology and Intensive Care, Hospital Municipal Dr Gilson de Cássia Marques de Carvalho, Sociedade Beneficente Israelita Brasileira Albert Einstein, São Paulo, Brazil.
Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
Clin Cardiol. 2025 Jun;48(6):e70165. doi: 10.1002/clc.70165.
Natriuretic peptides (NP) are widely used to diagnose heart failure (HF), but their role in guiding treatment remains uncertain. We performed a randomized trial meta-analysis comparing NP-guided therapy to usual care in acute decompensated HF.
We searched PubMed, Embase, and Cochrane for RCTs comparing NP-guided therapy to usual care in acute decompensated HF. Outcomes included all-cause mortality, cardiovascular death, and a composite of mortality and HF hospitalizations (reported as RR and 95% CI). Heterogeneity was assessed using I, and a random-effects model was applied when appropriate. Analyses were performed in R Studio 4.3.2.
We included 9 RCTs with 3992 patients, of whom 2007 (50.3%) underwent NP-guided treatment. The median follow-up was 12 months. All-cause mortality (RR: 0.84; 95% CI: 0.69-1.01; p = 0.069; I = 41%), cardiovascular death (RR: 0.91; 95% CI: 0.78-1.08; p = 0.287; I = 0%), and the composite outcome of HF hospitalization or cardiovascular death (RR: 0.91; 95% CI: 0.77-1.09; p = 0.308; I = 56%) were not significantly different between groups. The time to event analysis of all-cause mortality had a slightly significant advantage in favor of NP-guided therapy (HR: 0.81; 95% CI: 0.69-0.95; p = 0.01; I = 0%).
Although NP-guided therapy showed a statistically significant benefit in time to all-cause mortality, this was not consistently reflected across other endpoints, and its overall clinical impact remains uncertain.
利钠肽（NP）被广泛用于诊断心力衰竭（HF），但其在指导治疗方面的作用仍不确定。我们进行了一项随机试验荟萃分析，比较NP指导治疗与急性失代偿性HF常规治疗的效果。
我们在PubMed、Embase和Cochrane中检索了比较NP指导治疗与急性失代偿性HF常规治疗的随机对照试验（RCT）。结局指标包括全因死亡率、心血管死亡以及死亡率和HF住院的复合结局（以风险比（RR）和95%置信区间（CI）报告）。使用I²评估异质性，适当时应用随机效应模型。分析在R Studio 4.3.2中进行。
我们纳入了9项RCT，共3992例患者，其中2007例（50.3%）接受了NP指导治疗。中位随访时间为12个月。两组间全因死亡率（RR：0.84；95%CI：0.69 - 1.01；p = 0.069；I² = 41%）、心血管死亡（RR：0.91；95%CI：0.78 - 1.08；p = 0.287；I² = 0%）以及HF住院或心血管死亡的复合结局（RR：0.91；95%CI：0.77 - 1.09；p = 0.308；I² = 56%）均无显著差异。全因死亡率的事件时间分析显示NP指导治疗略有显著优势（风险比（HR）：0.81；95%CI：0.69 - 0.95；p = 0.01；I² = 0%）。
尽管NP指导治疗在全因死亡率的时间方面显示出统计学上的显著益处，但在其他终点未得到一致体现，其总体临床影响仍不确定。
