Biomarker Test Can Reduce Heart Failure Complications

(Yale School of Medicine/Wikimedia Commons)

A clinical trial at Massachusetts General Hospital in Boston indicates that testing for blood levels of a biomarker of cardiac distress, along with standard levels of care, can reduce the incidence of cardiac complications. The findings appear in the 25 October issue of the Journal of the American College of Cardiology (paid subscription required). Roche Diagnostics, which manufactures the assay used to test for the biomarker, supported the study.

The standard care for treating heart failure involves a combination of drugs such as beta blockers and diuretics, but offers few indicators that allow physicians to monitor their effectiveness, other than waiting for and responding to worsening symptoms.

The trial, conducted from 2005 to 2009, involved 151 patients with congestive heart failure — left ventricle systolic dysfunction. All patients received the standard care for heart failure, but a randomized half of the group also were tested regularly for amino-terminal pro–B-type natriuretic peptide (NT-proBNP), a hormone released from the heart in patients with heart failure.

In the trial, patients in the placebo group used measures such as blood pressure and heart rate to guide medication dosage. In the test group, on the other hand, patients were also regularly measured for NT-proBNP blood levels, with medications adjusted to reach the NT-proBNP target of less than 1,000 picograms per mililiter (pg/mL). The group overall, at the beginning of the trial, had an average level of more than 2,000 pg/mL.

In patients whose care was guided by the NT-proBNP test results, the rates of worsening heart failure symptoms and heart failure hospitalization were cut in half. Participants in this group also reported significantly better quality of life, compared with the standard care group. Patients in the test group were shown as well to have greater improvement in both the structure and function of the heart muscle, when measured by by echocardiograms. Elderly patients benefited as much by the biomarker test results as younger patients.

James Januzzi, associate professor of medicine at Harvard Medical School and study leader, says that biomarker-guided care “allows us to give the drugs we already have in a more individualized manner.” He notes, however, that the study results still “need to be replicated in a larger, multicenter trial, which is currently in the works, along with a study examining natriuretic peptide testing in the home.”

Read more: Clinical Trial Shows Drug Improves Heart Muscle Functions

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