NT-Pro BNP and Neopterin: very promising biomarkers for monitoring therapeutic effectiveness in chronic heart failure patients.

Previous studies have clearly established that increased Heart Rate (HR) increases mortality and cardiovascular events in patients with chronic heart failure.

Heart rate reduction is therefore one of the main therapeutic goals in these patients.

It is also established that some cardiac biomarkers such as NT-Pro BNP and Neopterin are related to morbidity and mortality in patients with Heart failure. Furthermore, levels of both these biomarkers are elevated in heart failure patients with NYHA class II-IV, and both are predictors of poor outcomes.

In this very interesting recent clinical study, the primary objective was to evaluate the short-term effects of ivabradine on NT-Pro BNP and neopterin, and the secondary objective was to evaluate the relationship between these two biomarkers with heart rate, NYHA class, and ejection fraction.

This was a prospective, 3-month, double-blind, parallel, interventional study in which 60 symptomatic, clinically stable patients with chronic systolic heart failure treated with standard therapy were randomized to an ivabradine-free group or an ivabradine addition therapy group.

The results were very promising:

• Significant decrease in NYHA class in the ivabradine group compared to the non-ivabradine group.

• Significant decrease in NT-Pro BNP and neopterin levels in the ivabradine group compared to the non-ivabradine group.

• Significant positive correlation between reduction in heart rate and reduction in levels of both biomarkers.

The results of this study strengthen the evidence for the effectiveness of ivabradine and provide strong evidence that NT-Pro BNP and neopterin levels could provide valuable tools not only to be used in the diagnosis, prognosis and monitor of HF therapy but also to evaluate ivabradine effectiveness in heart failure.

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1Clinical comparative study assessing the effect of ivabradine on neopterin and NT-Pro BNP against standard treatment in chronic heart failure patients. Eur J Clin Pharmacol. 2022 Mar 3. doi: 10.1007/s00228-022-03290-6.