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Nishikimi T, Nakagawa Y, Miyamoto S, Kanamori T, Inazumi H, Yanagisawa H, Moriuchi K, Kinoshita H, Tamamura Y, Takahama H, Minamino N, Ono K. Responses of B-type natriuretic peptide (BNP), mature BNP and proBNP to sacubitril/valsartan differs between responders and non-responders. Open Heart 2025; 12:e002990. [PMID: 39988342 PMCID: PMC11848661 DOI: 10.1136/openhrt-2024-002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 01/27/2025] [Indexed: 02/25/2025] Open
Abstract
BACKGROUND Earlier studies showed that measured changes in plasma B-type natriuretic peptide (BNP) levels are inconsistent after sacubitril/valsartan administration. The reason remains unknown but may reflect the fact that BNP immunoreactivity measured with commercial BNP assays (BNPcom) includes both mature BNP and proBNP, and neprilysin degrades only mature BNP. In addition, the responsiveness to sacubitril/valsartan varies among patients with heart failure. We investigated the mechanism underlying the inconsistency of BNP measurements after sacubitril/valsartan. METHODS We measured plasma mature BNP, proBNP and total BNP (mature BNP+proBNP) levels with our immunochemiluminescent assay as well as NT-proBNP, A-type natriuretic peptide (ANP) and BNPcom with conventional assays in 54 patients with heart failure, before (baseline) and after 2, 4, 8 and 12 weeks of sacubitril/valsartan administration. Responders were defined as having NT-proBNP levels at <70% of baseline after 12 weeks. RESULTS Among all patients, total BNP and BNPcom did not change with sacubitril/valsartan treatment, whereas NT-proBNP and proBNP decreased, mature BNP modestly increased and ANP greatly increased. Responders (n=31) exhibited smaller %changes in all natriuretic peptide levels than non-responders (n=23; all p<0.01). Receiver operating characteristic curves analysis to assess the ability of the %change in each natriuretic peptide at 4 weeks to detect responders showed that the area under the curve was about 0.80 for each peptide. There were good correlations between plasma natriuretic peptides levels at baseline and throughout the sacubitril/valsartan administration. CONCLUSION These results suggest that the magnitude and direction of change in each BNP form depends on its substrate specificity for neprilysin, that differences in plasma levels of each BNP form between responders and non-responders appear early and persist and that BNPcom levels at 4 weeks can be applicable to prediction of the responders. Notably, our findings show that the idea that BNPcom cannot be used as a marker of heart failure after sacubitril/valsartan should be reconsidered.
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Affiliation(s)
- Toshio Nishikimi
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Internal Medicine, Wakakusa-Tatsuma Rehabilitation Hospital, Daito, Osaka, Japan
| | - Yasuaki Nakagawa
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Preventive Medicine and Division of Cardiovascular Medicine, KITANO HOSPITAL PIIF Tazuke-kofukai, Osaka, Japan
| | - Shoichi Miyamoto
- Cardiology, Nishinomiya Watanabe Hospital, Nishinomiya, Hyogo, Japan
| | - Takahiko Kanamori
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideaki Inazumi
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Yanagisawa
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Moriuchi
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideaki Kinoshita
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Tamamura
- Rehabilitation, Wakakusa-Tatsuma Rehabilitation Hospital, Daito, Osaka, Japan
| | - Hiroyuki Takahama
- Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naoto Minamino
- Biochemistry, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koh Ono
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Manzi L, Buongiorno F, Narciso V, Florimonte D, Forzano I, Castiello DS, Sperandeo L, Paolillo R, Verde N, Spinelli A, Cristiano S, Avvedimento M, Canonico ME, Bardi L, Giugliano G, Gargiulo G. Acute Heart Failure and Non-Ischemic Cardiomyopathies: A Comprehensive Review and Critical Appraisal. Diagnostics (Basel) 2025; 15:540. [PMID: 40075788 PMCID: PMC11899404 DOI: 10.3390/diagnostics15050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/09/2025] [Accepted: 02/22/2025] [Indexed: 03/14/2025] Open
Abstract
Acute heart failure (AHF) is a complex clinical syndrome characterized by the rapid or gradual onset of symptoms and/or signs of heart failure (HF), leading to an unplanned hospital admission or an emergency department visit. AHF is the leading cause of hospitalization in patients over 65 years, thus significantly impacting public health care. However, its prognosis remains poor with high rates of mortality and rehospitalization. Many pre-existing cardiac conditions can lead to AHF, but it can also arise de novo due to acute events. Therefore, understanding AHF etiology could improve patient management and outcomes. Cardiomyopathies (CMPs) are a heterogeneous group of heart muscle diseases, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), non-dilated cardiomyopathy (NDLVC), and arrhythmogenic right ventricular cardiomyopathy (ARVC), that frequently present with HF. Patients with CMPs are under-represented in AHF studies compared to other etiologies, and therefore therapeutic responses and prognoses remain unknown. In DCM, AHF represents the most frequent cause of death despite treatment improvements. Additionally, DCM is the first indication for heart transplant (HT) among young and middle-aged adults. In HCM, the progression to AHF is rare and more frequent in patients with concomitant severe left ventricle (LV) obstruction and hypertrophy or severe LV systolic dysfunction. HF is the natural evolution of patients with RCM and HF is associated with poor outcomes irrespective of RCM etiology. Furthermore, while the occurrence of AHF is rare among patients with ARVC, this condition in NDLVC patients is currently unknown. In this manuscript, we assessed the available evidence on AHF in patients with CMPs. Data on clinical presentation, therapeutic management, and clinical outcomes according to specific CMPs are limited. Future HF studies assessing the clinical presentation, treatment, and prognosis of specific CMPs are warranted.
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Affiliation(s)
- Lina Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Federica Buongiorno
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Viviana Narciso
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Domenico Florimonte
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Imma Forzano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Domenico Simone Castiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Luca Sperandeo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Roberta Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
- Department of Cardiology, AORN Cardarelli, 80131 Naples, Italy
| | - Alessandra Spinelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Stefano Cristiano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (F.B.); (V.N.); (D.F.); (I.F.); (D.S.C.); (L.S.); (R.P.); (N.V.); (A.S.); (S.C.); (M.A.); (M.E.C.); (L.B.); (G.G.)
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Donald E, Hajduczok A, Campbell P. European Society of Cardiology Congress 2024 Meeting: Heart Failure Highlights. J Card Fail 2025; 31:140-143. [PMID: 39284510 DOI: 10.1016/j.cardfail.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 09/11/2024] [Indexed: 10/14/2024]
Affiliation(s)
- Elena Donald
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - Alexander Hajduczok
- Department of Cardiology, University of California San Diego Health, La Jolla, California
| | - Patricia Campbell
- Department of Cardiology, Craigavon Area Hospital, Southern Trust, Portadown, UK
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Tanaka A, Imai T, Kida K, Matsue Y, Node K. Angiotensin receptor-neprilysin inhibition and combination use of guideline-directed medical therapies in acute heart failure. Eur J Heart Fail 2025; 27:110-112. [PMID: 39523914 PMCID: PMC11798627 DOI: 10.1002/ejhf.3526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Takumi Imai
- Clinical Research DivisionOrganization for Clinical Medicine PromotionTokyoJapan
- Clinical and Translational Research CenterKobe University HospitalKobeJapan
| | - Keisuke Kida
- Department of PharmacologySt. Marianna University School of MedicineKawasakiJapan
| | - Yuya Matsue
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
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Doi S, Kida K, Nasu T, Ishii S, Kagiyama N, Fujimoto W, Kikuchi A, Ijichi T, Shibata T, Kanaoka K, Matsumoto S, Akashi YJ. Uptitration of Sacubitril/Valsartan and Outcomes in Patients With Heart Failure - Insight From the REVIEW-HF Registry. Circ J 2024; 89:93-100. [PMID: 39477485 DOI: 10.1253/circj.cj-24-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
BACKGROUND Guideline-directed medical therapy has become an important component of heart failure (HF) therapy, with sacubitril/valsartan as one of the recommended drugs; however, the real-world prognostic implications of sacubitril/valsartan uptitration are unclear. METHODS AND RESULTS Patients with HF newly initiated on sacubitril/valsartan were registered in a retrospective multicenter study (REVIEW-HF). In all, 995 patients were divided into 3 groups according to the maximum dose achieved: high dose, sacubitril/valsartan 400 mg; intermediate dose, sacubitril/valsartan 200-<400 mg; and low dose, sacubitril/valsartan <200 mg. A total of 397 (39.9%) patients received high-dose sacubitril/valsartan; they had a significantly lower risk of mortality or HF hospitalization than patients in the low-dose (hazard ratio [HR] 0.39; 95% confidence interval [CI] 0.29-0.53; P<0.001) and intermediate-dose (HR 0.64; 95% CI 0.45-0.94; P=0.03) groups. In the multivariable Cox regression model, higher systolic blood pressure and maintained geriatric nutritional risk index were significantly associated with a higher incidence of achieving a high dose of sacubitril/valsartan. Patients who did not receive high-dose sacubitril/valsartan experienced more hypotension during the follow-up period, whereas hyperkalemia, severe renal events, and angioedema did not differ across the achieved dose classifications. CONCLUSIONS Patients who achieved sacubitril/valsartan uptitration had a better prognosis than those who did not. Before sacubitril/valsartan uptitration, patients need to monitor blood pressure closely to prevent worsening events.
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Affiliation(s)
- Shunichi Doi
- Department of Cardiology, St. Marianna University School of Medicine
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
| | - Takahito Nasu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Wataru Fujimoto
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center
| | | | - Takeshi Ijichi
- Department of Cardiology, Tokai University School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow
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Bhatt AS, Vaduganathan M. Implementing medical therapy during worsening heart failure. Eur Heart J 2024; 45:4494-4496. [PMID: 39215533 DOI: 10.1093/eurheartj/ehae566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Ankeet S Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Muthiah Vaduganathan
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA
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