Dr Januzzi: Certain therapies may change the amount of glycosylation in the amino-terminal portion of the biomarker, which may allow for differences in measurements as well as differences in processing, improving heart failure status. There is a lot to this that still needs better understanding. […]
NT-proBNP vs Cardiac medications
What should be the timing of initiation for SGLT2 inhibitors in patients with acute heart failure and how should Neprilysin inhibitors be used in acute heart failure with these two new therapies?
Dr Sim: There is an ongoing trial looking at the use of SGLT2 inhibitors in acute heart failure settings. The result should be out in a couple of years. In acute heart failure setting (like the design in PIONEER–HF trial), after the first 24 to 48 hours when the patient is stabilised in terms of the […]
Should we forget about symptoms and just use NT-proBNP as the way that we decide who gets an ARNi or who gets a SGLT2i?
Dr Sim: In practice, we should go with both symptoms and NT-proBNP. It is hard to ignore the symptoms. It does not cost a single cent to ask a patient for history; it is something very easy. NT-proBNP is mainly done for two reasons – One, beside symptoms, NT-proBNP gives us more information about the prognosis, […]
Is there a target for treatment for heart failure with reduced ejection fraction?
Dr Januzzi: For chronic heart failure with reduced ejection fraction, the target is less than 1000 pg/mL. Below a 1000 pg/mL value, indicates ventricular remodelling begins to improve. That would be the target for chronic ambulatory heart failure. For inpatient heart failure management, there is a wide range of values in patients that are hospitalised. 30% […]
How should we use NT-proBNP guided therapy and anticipate that NT-proBNP is augmented in patients with chronic heart failure and acute kidney injury?
Dr Sim : Most of the time in Singapore, when a patient is received from the emergency department, an NT-proBNP would have been done. ED physicians are very aggressive in ordering the NT-proBNP so that the results would be quick. In the setting of pneumonia, acute kidney injury, they would definitely affect the NT-proBNP result. […]