Natriuretic peptides for diagnosis, prognosis, and management of heart failure

Abstract

Heart failure is a complex syndrome that affects millions of people, and the incidence is rising steeply. The use of biomarkers, and especially the natriuretic peptides, has been increasingly investigated to assist in the care of these patients. Since the discovery of the natriuretic peptides over 30 years ago, significant progress in understanding these molecules has been achieved. The biological effects of the natriuretic peptides consist primarily of fluid balance, vasodilation, and maintenance of cardiovascular homeostasis, and the primary trigger of natriuretic peptide release is cardiac myocyte stretch from either volume or pressure overload. Over the last several years, multiple studies have been conducted involving particularly B-type natriuretic peptide (BNP) and aminoterminal pro-B-type natriuretic peptide (NT-proBNP) which focused on the utility of both for the diagnosis, prognosis, and management of heart failure. These studies have resulted in establishing a crucial role for the natriuretic peptides as an adjunct to clinical assessment of these complicated patients. In addition to their use in heart failure with reduced ejection fraction, data continue to emerge regarding their utility in heart failure with preserved ejection fraction as well as for heart failure screening. In the future, measurement of natriuretic peptides will be increasingly useful for personalized care of patients with heart failure and further integrated into routine care of patients with a wide array of related cardiac conditions.