The PARADIGM-HF trial established sacubitril/valsartan (ARNI) as superior to enalapril in HFrEF. Sacubitril inhibits neprilysin, leading to accumulation of natriuretic peptides. Importantly, this renders which biomarker unreliable for HF monitoring after initiating ARNI therapy?

• A Serum troponin I
• B NT-proBNP (N-terminal proBNP)
• C Serum creatinine
• D BNP (B-type natriuretic peptide) ✓

Explanation

Sacubitril inhibits neprilysin, the enzyme that degrades BNP, leading to markedly elevated circulating BNP levels despite clinical improvement. Therefore, BNP cannot be used to monitor HF status on ARNI therapy. NT-proBNP is NOT a neprilysin substrate and is therefore NOT affected by sacubitril — it accurately reflects cardiac filling pressures and can be used for monitoring on ARNI. This is a high-yield distinction: BNP increases, NT-proBNP is reliable, troponin and creatinine are unaffected by neprilysin inhibition.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.