Abstract
Natriuretic peptide [NP; B-type NP (BNP), N-terminal proBNP (NT-proBNP), and midregional proANP (MR-proANP)] concentrations are quantitative plasma biomarkers for the presence and severity of haemodynamic cardiac stress and heart failure (HF). End-diastolic wall stress, intracardiac filling pressures, and intracardiac volumes seem to be the dominant triggers. This paper details the most important indications for NPs and highlights 11 key principles underlying their clinical use shown below. NPs should always be used in conjunction with all other clinical information. NPs are reasonable surrogates for intracardiac volumes and filling pressures. NPs should be measured in all patients presenting with symptoms suggestive of HF such as dyspnoea and/or fatigue, as their use facilitates the early diagnosis and risk stratification of HF. NPs have very high diagnostic accuracy in discriminating HF from other causes of dyspnoea: the higher the NP, the higher the likelihood that dyspnoea is caused by HF. Optimal NP cut-off concentrations for the diagnosis of acute HF (very high filling pressures) in patients presenting to the emergency department with acute dyspnoea are higher compared with those used in the diagnosis of chronic HF in patients with dyspnoea on exertion (mild increase in filling pressures at rest). Obese patients have lower NP concentrations, mandating the use of lower cut-off concentrations (about 50% lower). In stable HF patients, but also in patients with other cardiac disorders such as myocardial infarction, valvular heart disease, atrial fibrillation or pulmonary embolism, NP concentrations have high prognostic accuracy for death and HF hospitalization. Screening with NPs for the early detection of relevant cardiac disease including left ventricular systolic dysfunction in patients with cardiovascular risk factors may help to identify patients at increased risk, therefore allowing targeted preventive measures to prevent HF. BNP, NT-proBNP and MR-proANP have comparable diagnostic and prognostic accuracy. In patients with shock, NPs cannot be used to identify cause (e.g. cardiogenic vs. septic shock), but remain prognostic. NPs cannot identify the underlying cause of HF and, therefore, if elevated, must always be used in conjunction with cardiac imaging.
| Original language | English |
|---|---|
| Pages (from-to) | 715-731 |
| Number of pages | 17 |
| Journal | European Journal of Heart Failure |
| Volume | 21 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:Natriuretic peptides are the gold standard biomarkers for HF diagnosis and prognosis. The measurement of NPs can help clinicians to manage patients in several clinical scenarios. They are helpful in screening to identify or exclude cardiac disease, for the differential diagnosis of symptoms that might be due to HF and are robust powerful prognostic tools. Each NP has specific cut-off concentrations. Plasma concentrations should be interpreted in the context of the clinical setting and as a quantitative marker of HF. The incremental value of NP-guided therapy remains controversial. Conflict of interest: C.M. was supported by grants from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, the University of Basel, Abbott, ALERE, BRAHMS, and Pronota. In addition, he received lecture fees from Abbott, ALERE, BRAHMS, Novartis and Roche. A.J.S.C. reports personal fees from Astra Zeneca, Faraday, WL Gore, Menarini, Respicardia, Servier, Stealth Peptides, Actimed, Vifor, and Verona, outside the submitted work. P.M.S. reports grants/research supports from Ministry of education, science and technological development of Republic of Serbia; receipt of honoraria or consultation fees from Servier, Boehringher Ingelheim, Hemofarm, Novartis, Astra Zeneca; participation in a company sponsored speaker’s bureau: Fondazione Internazionale Menarini. R.A.d.B. reports grants from AstraZeneca, Bristol Myers Squibb, Trevena, Novo Nordisk, and other from ThermoFisher, Roche; personal fees from AstraZeneca, Novartis, Vifor, MandalMed, Inc., and other from scPharmaceuticals, Inc, outside the submitted work. J.G.F.C. reports personal fees from Johnson & Johnson, during the conduct of the study; and grants and personal fees from Amgen, Bayer, Bristol Myers Squibb, Philips, Stealth Biopharmaceuticals,
Publisher Copyright:
© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology