Why the study?
Does sacubitril/valsartan initiation alter the short-term dynamics of natriuretic peptides during acute volume changes in patients with HFrEF?
Observational (n=229)
Does sacubitril/valsartan initiation alter the short-term dynamics of natriuretic peptides during acute volume changes in patients with HFrEF?
BNP and NT-proBNP dynamics lag behind clinical decongestion during acute volume changes, indicating that very short-term serial measurements may not add clinical value in early acute heart failure.
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Avoid routine short-interval NP testing in early acute HF; cohort data supports clinical assessment alone and leaves optimal biomarker timing open.
INTRODUCTION: Natriuretic peptides (NPs) are central to the diagnostic and therapeutic management of heart failure (HF), yet their short-term dynamics under sacubitril/valsartan (S/V) therapy and during acute volume changes remain incompletely characterized. We aimed to assess changes in circulating biomarkers and response to standardized acute intravascular volume expansion and diuretic treatment before and after S/V initiation. METHODS: We studied 229 ambulatory patients with HF with reduced ejection fraction receiving guideline-directed medical therapy who initiated S/V. Patients were evaluated at three outpatient visits: before S/V initiation and after 2 and 3 months of treatment. At each visit, participants underwent a standardized 9-hour protocol including volume infusion followed by diuretic administration. BNP, NT-proBNP, MR-proANP, and neprilysin activity were measured serially alongside clinical assessment and natriuresis. RESULTS: Across visits, initiation of S/V was associated with lower concentrations of BNP (-8%, P = .009) and NT-proBNP (-35%, P < .001). During the acute protocol, both BNP and NT-proBNP increased significantly over time (timepoint effect P < .001), with parallel trajectories before and after S/V initiation and no visit-by-time interaction (P = .17 for BNP; P = .95 for NT-proBNP). Despite marked natriuresis and improvement in clinical signs following diuretic administration, BNP and NT-proBNP continued to rise during the 9-hour observation period. CONCLUSION: In a controlled acute volume overload setting, BNP and NT-proBNP provide comparable information, but their short-term dynamics lag behind clinical decongestion. Routine serial NP measurements at very short time intervals are unlikely to add incremental clinical value in the early phase of acute HF.
Bruno et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (n=229). Sacubitril/valsartan vs. Before sacubitril/valsartan initiation was evaluated on Changes in BNP and NT-proBNP concentrations (p=0.009 for BNP; <0.001 for NT-proBNP).
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