383. Guidelines: 2022 AHA/ACC/HFSA Guide...

A 63-year-old man with a past medical history of hypertension and type 2 diabetes mellitus presents for routine follow-up. He reports feeling in general good health and enjoys 2-mile walks daily. A review of systems is negative for any symptoms. Which of the following laboratory studies may be beneficial for screening?

A

NT-proBNP

B

CK-MB

C

Troponin

D

C-reactive protein

E

None of the above

Explanation

The correct answer is A – NT-proBNP.

This patient is at risk for HF (Stage A) given the presence of risk factors (hypertension and type 2 diabetes mellitus) but the absence of signs or symptoms of heart failure.

Patients at risk for HF screened with BNP or NT-proBNP followed by collaborative care, diagnostic evaluation, and treatment in those with elevated levels can reduce combined rates of LV systolic dysfunction, diastolic dysfunction, and HF.

The STOP-HF (St Vincent’s Screening to Prevent Heart Failure) study was a large single-center trial of patients at risk of HF that showed BNP-based screening reduced the composite endpoint of incident asymptomatic LV dysfunction with or without newly diagnosed HF.

Therefore, for patients at risk of developing HF, natriuretic peptide biomarker-based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to

prevent the development of LV dysfunction (systolic or diastolic) or new-onset HF (Class 2a, LOE B-R).

There is no indication for measuring troponin, CK-MB, or CRP at this time.

Main Takeaway

In patients at risk for HF, screening for pre-HF using natriuretic peptide testing followed by team-based care may be helpful for preventing disease progression.  

Guideline Loc.

Section 5.1