title: The role of natriuretic peptides for the diagnosis of left ventricular dysfunction.
abstract: Natriuretic peptides (NPs) are entered in current guidelines for heart failure (HF) diagnosis and management because of their high specificity and sensibility in screening patients with acute dyspnea. Due to their availability and relatively low cost, they became the first step examinations in HF patients evaluation at hospital admission together with clinical and chest radiography examination. NPs are released following any cardiac haemodynamic stress due to volume or pressure overload and should be considered as a mirror of cardiac condition helping in recognizing patients with poor outcome. Moreover, the exact role of NPs in early HF stages, in isolated diastolic dysfunction, and in general population is questioned. Several promising reports described their potential role; however, the wide cut-off definition, inclusion criteria, and intrinsic measurement biases do not actually consent to their clinical application in these settings. A multimodality strategy including both NPs and imaging studies appears to be the best strategy to define the cardiac dysfunction etiology and its severity as well as to identify patients with higher risk. In this review, we describe the current and potential role of NPs in patients with asymptomatic cardiac insufficiency, evaluating the requirement to obtain a better standardization for imaging as for laboratory criteria.
authors.affiliation: Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, 53100 Siena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.forename: Matteo
authors.initials: M
authors.lastname: Beltrami
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ruocco
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
mesh_terms: D016477:Artifacts; D015415:Biomarkers; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003971:Diastole; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000097:blood / Q000150:complications; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D012015:Reference Standards; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D010446:Peptide Fragments; D049994:Sodium Potassium Chloride Symporter Inhibitors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain