Zusammenfassung
Bei Patienten mit akuter Dyspnoe können Biomarker helfen zwischen akuter Herzinsuffizienz und Luftnot nichtkardialer Genese zu unterscheiden. Hierbei sind vor allem die natriuretischen Peptide von großer praktischer Bedeutung. Sie sollten im Rahmen der Aufnahme bei allen Patienten mit akuter Luftnot bestimmt werden. Einen hohen Stellenwert hat insbesondere deren hoher negativer prädiktiver Wert, der den weitgehenden Ausschluss einer Herzinsuffizienz bei normwertigen natriuretischen Peptiden erlaubt. Zur Verfügung stehen Assays für das natriuretische Peptid vom B‑Typ (BNP), das N‑terminale pro-natriuretische Peptid vom B‑Typ (NT-proBNP) und das mittregionale pro-atriale natriuretische Peptid (MR-proANP) mit unterschiedlichen Grenzwerten. Bei Patienten, die mit einem Angiotensinrezeptor-Neprilysin-Inhibitor behandelt werden, muss NT-proBNP (oder MR-proANP) zur Beurteilung verwendet werden, da BNP durch die Medikamentenwirkung gesteigert wird und daher keine adäquate Aussage zur Krankheitsschwere zulässt. Neben der gut etablierten diagnostischen Bedeutung bei der akuten Herzinsuffizienz können die natriuretischen Peptide auch eine Rolle bei der Beurteilung der Krankheitsschwere und bei der Prognoseabschätzung spielen. Neben den natriuretischen Peptiden existieren zahlreiche weitere Biomarker, die verschiedene pathophysiologische Vorgänge der Herzinsuffizienz widerspiegeln. Ob diese Biomarker den Sprung in die klinische Routine schaffen, bleibt abzuwarten.
Abstract
Biomarkers may help to rapidly differentiate heart failure from noncardiac causes of acute dyspnea. Natriuretic peptides are especially useful for this purpose and should be measured in all patients presenting with acute onset dyspnea. Due to their excellent negative predictive value, a normal serum concentration of natriuretic peptides makes acute heart failure unlikely. Assays exist for B‑type natriuretic peptide (BNP), N‑terminal pro-B-type natriuretic peptide (NT-proBNP) and midregional pro-atrial natriuretic peptide (MR-proANP) with established cut-offs in the acute setting. Importantly, in patients treated with an angiotensin receptor-neprilysin inhibitor (ARNI), NT-proBNP (or MR-proANP) should be used instead of BNP, since the latter is increased by ARNI treatment. Besides their established diagnostic value in heart failure patients, the measurement of natriuretic peptides provides prognostic information and may help in guiding therapy. Additionally, multiple other biomarkers reflect several pathophysiological processes involved in heart failure patients. Their diagnostic and prognostic impact in heart failure needs to be established.
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S. von Haehling hat Honorare für Beratung von den Firmen Bayer, BRAHMS/Thermo Fisher und Roche erhalten. K. Hellenkamp gibt an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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G. Hasenfuß, Göttingen
S. von Haehling, Göttingen
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Hellenkamp, K., von Haehling, S. Bedeutung von Biomarkern bei akuter Herzinsuffizienz. Internist 60, 587–596 (2019). https://doi.org/10.1007/s00108-019-0606-7
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DOI: https://doi.org/10.1007/s00108-019-0606-7
Schlüsselwörter
- Natriuretisches Peptid vom B‑Typ
- N-terminales pro-natriuretisches Peptid vom B‑Typ
- Mittregionales pro-atriales natriuretisches Peptid
- Prognose der akuten Herzinsuffizienz
- Akute Dyspnoe