State of the art: using natriuretic peptide levels in clinical practice.
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: 1) NP levels are quantitative plasma biomarkers of heart failure (HF). 2) NP levels are accurate in the diagnosis of HF. 3) NP levels may help risk stratify emergency department (ED) patients with regard to the need for hospital admission or direct ED discharge. 4) NP levels help improve patient management and reduce total treatment costs in patients with acute dyspnoea. 5) NP levels at the time of admission are powerful predictors of outcome in predicting death and re-hospitalisation in HF patients. 6) NP levels at discharge aid in risk stratification of the HF patient. 7) NP-guided therapy may improve morbidity and/or mortality in chronic HF. 8) The combination of NP levels together with symptoms, signs and weight gain assists in the assessment of clinical decompensation in HF. 9) NP levels can accelerate accurate diagnosis of heart failure presenting in primary care. 10) NP levels may be helpful to screen for asymptomatic left ventricular dysfunction in high-risk patients.
Maisel
Alan
A
VA San Diego Healthcare System Cardiology, San Diego, CA 92161, USA. amaisel@ucsd.edu
Mueller
Christian
C
Adams
Kirkwood
K
Anker
Stefan D
SD
Aspromonte
Nadia
N
Cleland
John G F
JG
Cohen-Solal
Alain
A
Dahlstrom
Ulf
U
DeMaria
Anthony
A
Di Somma
Salvatore
S
Filippatos
Gerasimos S
GS
Fonarow
Gregg C
GC
Jourdain
Patrick
P
Komajda
Michel
M
Liu
Peter P
PP
McDonagh
Theresa
T
McDonald
Kenneth
K
Mebazaa
Alexandre
A
Nieminen
Markku S
MS
Peacock
W Frank
WF
Tubaro
Marco
M
Valle
Roberto
R
Vanderhyden
Marc
M
Yancy
Clyde W
CW
Zannad
Faiez
F
Braunwald
Eugene
E