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Eur Heart J Acute Cardiovasc Care. 2017 Jun;6(4):321-328. doi: 10.1177/2048872615626355. Epub 2016 Jan 12.

Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?

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1 Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Austria.
2 Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Sweden.
3 Medizinische Klinik III, University of Heidelberg, Germany.
4 Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Austria.
5 Department of Cardiology, Aarhus University Hospital, Denmark.
6 Department of Laboratory Medicine, University Hospital Padova, Italy.
7 Division of Emergency Medicine and Department of Cardiology, Charité- Universitätsmedizin Berlin, Germany.
8 Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
9 Mayo Clinic and Medical School, USA.


Since the approval of sacubitril-valsartan for the treatment of chronic heart failure with reduced ejection fraction, a commonly raised suspicion is that a wider clinical use of this new drug may diminish the clinical utility of B-type natriuretic peptide testing as sacubitril may interfere with B-type natriuretic peptide clearance. In this education paper we critically assess this hypothesis based on the pathophysiology of the natriuretic peptide system and the limited published data on the effects of neprilysin inhibition on natriuretic peptide plasma concentrations in humans. As the main clinical application of B-type natriuretic peptide testing in acute cardiac care is and will be the rapid rule-out of suspected acute heart failure there is no significant impairment to be expected for B-type natriuretic peptide testing in the acute setting. However, monitoring of chronic heart failure patients on sacubitril-valsartan treatment with B-type natriuretic peptide testing may be impaired. In contrast to N-terminal-proBNP, the current concept that the lower the B-type natriuretic peptide result in chronic heart failure patients, the better the prognosis during treatment monitoring, may no longer be true.


B-type natriuretic peptide; Sacubitril-valsartan; acute cardiac care; diagnosis; heart failure; natriuretic peptides

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