Use of NT-proBNP for the screening, diagnosis and risk-stratification of left ventricular dysfunction

Abstract

Heart failure (HF) is a major health problem, and preventing the onset of heart failure could have large cost implications for healthcare systems globally. Screening for heart failure and its precursor, left ventricular dysfunction, could allow patients to receive therapies shown to reduce the risk of incident heart failure, such as ACE inhibitors and beta blockers. Using echocardiography to screen patients is costly. Natriuretic peptides could be used to screen populations for asymptomatic left ventricular function. However, natriuretic peptide levels vary by age, sex and presence of comorbidities such as atrial fibrillation and kidney disease. Using one threshold value in a large population may impair the sensitivity and specificity of such an approach, but prior studies in community-based adults suggest that this is a feasible strategy. A higher yield strategy would be to screen high-risk patients, such as those with diabetes mellitus, and current guidelines for the management of diabetes suggest using natriuretic peptides to screen patients for unrecognised heart failure. Natriuretic peptides can also help ascertain the risk of future cardiovascular events and deaths in patients with diabetes. Natriuretic peptides have established themselves as a central part of the definition of heart failure. However, more work needs to be done to determine the optimal age, sex and body weight-based thresholds, as well as thresholds for those with comorbidities like atrial fibrillation and chronic kidney disease. These are needed to determine and optimise the sensitivity and specificity of natriuretic peptides in the diagnosis of heart failure. Clinicians should use guideline-recommended thresholds to diagnose HF with natriuretic peptides but consider factors that influence levels, such as age, kidney function, etc. It is yet unclear if natriuretic peptides can be used to guide the management of patients with heart failure.