{"id":"8e1304fbae30","type":"article","url":"https://hartvaat.nl/2026/03/16/natrium-hf-subanalyse-natriuretische-peptiden-lopen-achter-op-de-klinische-ontst/","title":"Natrium-HF-subanalyse: natriuretische peptiden lopen achter op de klinische ontstuwing bij hartfalen","title_en":"Cardiac Biomarkers Response Under Angiotensin Receptor-Neprilysin Inhibitor: A Sub-Analysis of the Natrium-HF Study","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","nt-probnp"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag075","source_url":"https://doi.org/10.1093/eschf/xvag075","authors":["Jolie Bruno","Aziz Daghmouri","Malha Sadoune","Romane Lafontaine","Alexis Nguyen","Christopher Edwards","Beth Davison","Gad Cotter","Koji Takagi","Christos Varounis","Priyanka Morishetty","Feriel Azibani","Elisabeth Masson","Camille Chenevier-Gobeaux","Alexandre Mebazaa","Benjamin Deniau"],"significance":6,"published":"2026-03-16","source_date":"2026-03-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"Natriuretic peptides (NPs) guide heart-failure diagnosis and treatment, but their short-term dynamics under sacubitril/valsartan (S/V) and during acute volume changes are incompletely characterised. In this sub-analysis of the Natrium-HF study, 229 ambulatory HFrEF patients started S/V; at three visits (before start and after 2 and 3 months) they underwent a standardised 9-hour protocol of volume infusion followed by diuretics. S/V initiation lowered BNP by 8% and NT-proBNP by 35%. During the acute protocol, however, both BNP and NT-proBNP rose significantly with identical trajectories before and after S/V — and kept rising despite marked natriuresis and clinical improvement after diuretics. BNP and NT-proBNP thus convey comparable information, but their short-term dynamics lag behind clinical decongestion; very-short-interval serial measurements likely add little in the early phase of acute heart failure.","created":"2026-07-03T10:32:19Z","updated":"2026-07-03T18:39:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Natriuretische peptiden (NP's) sturen de diagnostiek en behandeling van hartfalen, maar hun kortetermijndynamiek onder sacubitril/valsartan (S/V) en tijdens acute volumeveranderingen is onvolledig in kaart gebracht. In deze subanalyse van de Natrium-HF-studie kregen 229 poliklinische HFrEF-patiënten S/V; bij drie bezoeken (vóór start en na 2 en 3 maanden) ondergingen zij een gestandaardiseerd 9-uursprotocol met volume-infusie gevolgd door diuretica. Het starten van S/V verlaagde het BNP met 8% en het NT-proBNP met 35%. Tijdens het acute protocol stegen BNP en NT-proBNP echter beide significant en met een identiek beloop vóór en na S/V — en bleven stijgen ondanks duidelijke natriurese en klinische verbetering na diuretica. BNP en NT-proBNP geven dus vergelijkbare informatie, maar hun kortetermijndynamiek loopt achter op de klinische ontstuwing; herhaald meten met zeer korte tussenpozen voegt in de vroege fase van acuut hartfalen waarschijnlijk weinig toe.","abstract_original":"AIMS: 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 = 0.009) and NT-proBNP (-35%, p < 0.001). During the acute protocol, both BNP and NT-proBNP increased significantly over time (timepoint effect p < 0.001), with parallel trajectories before and after S/V initiation and no visit-by-time interaction (p = 0.17 for BNP; p = 0.95 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."}