Biomarker-Guided Versus Clinically Guided Management Strategies for Heart Failure: A Systematic Review and Meta-Analysis.

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2026-03-23 eCollection Date: 2026-03-01 DOI:10.31083/RCM46184

Hao Zhou, Ting Liu, Fuxia Lan, Kai Liu, Xin Wei, Ying Xu

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引用次数: 0

Abstract

Background: The clinical value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy for improving outcomes in patients with heart failure (HF) remains controversial. Thus, this meta-analysis synthesizes the available evidence from randomized controlled trials (RCTs) to determine whether a biomarker-guided strategy reduces all-cause mortality and HF-related hospitalizations compared with clinically guided management.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science databases from inception to May 2025 for RCTs comparing biomarker-guided versus clinically guided management in patients with HF. Pooled risk ratios (RRs) were calculated using a random-effects model. We performed extensive supplementary analyses, including a subgroup analysis, sensitivity analysis, and trial sequential analysis (TSA).

Results: We included 17 articles (reporting on 17 distinct RCTs) comprising 5069 patients. The primary meta-analysis showed that biomarker-guided therapy was associated with a significant reduction in all-cause mortality (RR 0.84, 95% confidence interval (CI) 0.73-0.96; I² = 12.2%) and HF-related hospitalizations (RR 0.79, 95% CI 0.65-0.96; I² = 53.7%). However, the robustness of these findings was undermined by subsequent analyses. Meanwhile, a sensitivity analysis restricted to studies with a low risk of bias rendered the mortality benefit non-significant (RR 0.90, 95% CI 0.79-1.03). Egger's test indicated potential publication bias (p = 0.0285), and TSA suggested the cumulative evidence was insufficient to draw a definitive conclusion.

Conclusions: Although there is a trend toward benefit, the existing evidence for biomarker-guided HF therapy is deemed "very low" quality based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment. The results were compromised by methodological deficiencies in primary studies and potential publication bias. Therefore, the evidence is inadequate to support the routine use of this strategy in clinical practice. Further large-scale, high-quality RCTs are warranted.

The prospero registration: CRD420250652134, https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652134.

查看原文本刊更多论文

生物标志物引导与临床指导的心力衰竭管理策略：系统回顾和荟萃分析。

背景：b型利钠肽（BNP）或n端前b型利钠肽（NT-proBNP）引导治疗对改善心力衰竭（HF）患者预后的临床价值仍存在争议。因此，本荟萃分析综合了随机对照试验（rct）的现有证据，以确定与临床指导管理相比，生物标志物指导策略是否能降低全因死亡率和hf相关住院率。方法：本系统评价遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。我们对PubMed、Embase、Cochrane图书馆和Web of Science数据库进行了系统检索，从成立到2025年5月，比较了生物标志物引导与临床指导治疗HF患者的随机对照试验。综合风险比（rr）采用随机效应模型计算。我们进行了广泛的补充分析，包括亚组分析、敏感性分析和试验序列分析（TSA）。结果：我们纳入了17篇文章（报告了17个不同的随机对照试验），包括5069例患者。初步荟萃分析显示，生物标志物引导治疗与全因死亡率显著降低相关(RR 0.84, 95%可信区间（CI） 0.73-0.96；I2 = 12.2%)和hf相关住院（RR 0.79, 95% CI 0.65-0.96; I2 = 53.7%）。然而，这些发现的稳健性被随后的分析破坏了。同时，敏感性分析仅限于低偏倚风险的研究，死亡率获益不显著（RR 0.90, 95% CI 0.79-1.03）。Egger的检验显示了潜在的发表偏倚（p = 0.0285）， TSA认为累积的证据不足以得出明确的结论。结论：尽管有获益的趋势，但基于推荐、评估、发展和评价分级（GRADE）评估，生物标志物引导的心衰治疗的现有证据被认为质量“非常低”。初步研究的方法学缺陷和潜在的发表偏倚影响了结果。因此，证据不足以支持在临床实践中常规使用该策略。进一步的大规模、高质量的随机对照试验是必要的。普洛斯彼罗注册：CRD420250652134， https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652134。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.