© 2008 European Society of Cardiology
State of the art: Using natriuretic peptide levels in clinical practice
a VA San Diego Healthcare System, United States
b University Hospital Basel Switzerland
c University of North Carolina Chapel Hill, United States
d Charite, Campus Virchow-Klinikum Berlin Germany
e San Spirito Hospital Rome Italy
f Castle Hill Hospital, University of Hull Kingston-upon-Hull, UK
g Hopital Lariboisiere Paris France
h Linkoping University Hospital Linkoping Sweden
i University of California San Diego, United States
j Sant'Andrea Hospital University La Sapienza Rome Italy
k Athens University Hospital Attikon Athens Greece
l University of California Los Angeles, United States
m Paris Descartes University Paris France
n University Pierre & Marie Curie Paris 6 Department of Cardiology, Pitie Salpetriere Hospital Paris France
o University of Toronto Canada
p Royal Brompton Hospital London UK
q St. Vincents University Hospital Dublin Ireland
r University Paris 7 Diderot, Hopital Lariboisiere Paris France
s Helsinki University Central Hospital Helsinki, Finland
t The Cleveland Clinic Cleveland Ohio, United States
u San Filippo Neri Hospital Rome Italy
v Centro per lo Scompenso Ospedale Civile San Dona di Piave, Italy
w Onze Lieve Vrouwe Ziekenhuis Aalst Belgium
x Baylor University Medical Center Dallas Texas, United States
y Inserm Centre d'Investigation Cliniques Nancy France
z Brigham and Women's Hospital Boston Massachusetts, United States
* Corresponding author. VASDHS Cardiology 9111-A, 3350 La Jolla Village Drive, San Diego, CA 92161, United States. E-mail address: amaisel{at}ucsd.edu (A. Maisel).
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Abstract |
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Natriuretic peptide (NP) levels (B-type natriuretic peptide (BNP) and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research throughout the world and have been incorporated into most national and international cardiovascular guidelines for heart failure. The role of NP levels in state-of-the-art clinical practice is evolving rapidly. This paper reviews and highlights ten key messages to clinicians:
- NP levels are quantitative plasma biomarkers of heart failure (HF).
- NP levels are accurate in the diagnosis of HF.
- NP levels may help risk stratify emergency department (ED) patients with regard to the need for hospital admission or direct ED discharge.
- NP levels help improve patient management and reduce total treatment costs in patients with acute dyspnoea.
- NP levels at the time of admission are powerful predictors of outcome in predicting death and re-hospitalisation in HF patients.
- NP levels at discharge aid in risk stratification of the HF patient.
- NP-guided therapy may improve morbidity and/or mortality in chronic HF.
- The combination of NP levels together with symptoms, signs and weight gain assists in the assessment of clinical decompensation in HF.
- NP levels can accelerate accurate diagnosis of heart failure presenting in primary care.
- NP levels may be helpful to screen for asymptomatic left ventricular dysfunction in high-risk patients.
Key Words: Natriuretic peptides • Clinical practice • Diagnosis
Received June 30, 2008; Revised July 14, 2008; Accepted July 17, 2008
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