title: Natriuretic peptides.
abstract: Natriuretic peptides (NPs) are released from the heart in response to pressure and volume overload. B-type natriuretic peptide (BNP) and N-terminal-proBNP have become important diagnostic tools for assessing patients who present acutely with dyspnea. The NP level reflects a compilation of systolic and diastolic function as well as right ventricular and valvular function. Studies suggest that using NPs in the emergency department can reduce the consumption of hospital resources and can lower costs by either eliminating the need for other, more expensive tests or by establishing an alternative diagnosis that does not require hospital stay. Caveats such as body mass index and renal function must be taken into account when analyzing NP levels. Natriuretic peptide levels have important prognostic value in multiple clinical settings, including in patients with stable coronary artery disease and with acute coronary syndromes. In patients with decompensated heart failure due to volume overload, a treatment-induced drop in wedge pressure is often accompanied by a rapid drop in NP levels. Knowing a patient's NP levels might thus assist with hemodynamic assessment and subsequent treatment titration. Monitoring NP levels in the outpatient setting might also improve patient care and outcomes.
authors.affiliation: Division of Cardiology, University of California at San Diego, and Veteran's Affairs San Diego Healthcare System, San Diego, California 92037-1300, USA. loridaniels@ucsd.edu
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008991:Monitoring, Physiologic; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D020098:Natriuretic Peptide, C-Type / Q000097:blood*; D009765:Obesity / Q000503:physiopathology / Q000628:therapy; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D006435:Renal Dialysis; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015431:Weight Loss / Q000502:physiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type; D009320:Atrial Natriuretic Factor