Natriuretic peptides (BNP and NT-proBNP): measurement and relevance in heart failure

Abstract

For patients presenting with acute dyspnea, an incorrect diagnosis could increase the mortality risk. When used in the evaluation of patients with acute symptoms, brain natriuretic peptide and N-terminal pro-brain natriuretic peptide (BNP and NT-proBNP, respectively) testing is highly sensitive for the diagnosis or exclusion of acute or chronic decompensated heart failure (HF). It has been demonstrated that BNP and proBNP levels can facilitate diagnosis and guide HF therapy. Natriuretic peptide (NP) levels are strictly related with HF severity; they are particularly increased in more advanced New York Heart Association (NYHA) classes and in patients with poor outcome. Therefore elevated NP levels were found to correlate with the severity of left ventricular systolic dysfunction, right ventricular dysfunction and pressures, and left ventricular filling alterations. However, the optimal use of NP determination agrees with patient history, physical examination, and all other diagnostic tools. There are some clinical conditions (ie, obesity, renal insufficiency anemia) for which the NP measurement is not diagnostic. Algorithm building taking into consideration all clinical and echocardiographic parameters, as well as NP measurements, may lead to the earlier identification and better risk stratification of patients with chronic HF, independently from etiology.

Keywords: diagnosis; echocardiography; heart failure; natriuretic pepides.

Figure 1

Classification of acute and chronic heart failure on the basis of coronary diseases and systolic dysfunction presence. Modified with permission from Gheorghiade M, Pang PS. Acute heart failure syndromes.J Am Coll Cardiol. 2009;53:557–573. Copyright © 2009 Elsevier. Abbreviations: HF, heart failure; CAD, coronary artery disease; EF, ejection fraction.

Figure 2

Decisional algorithm for HF diagnosis on the basis of NP measurement: in case of NP values in the gray zone it is necessary to confirm or exclude diagnosis by echocardiography Abbreviations: ECG, electrocardiogram EF, ejection fraction; NP, natriuretic peptide; BNP, brain natriuretic peptide; NT-proBNP, N-terminal probrain natriuretic peptide; HF, heart failure; LV, left ventricle; MR, mitral regurgitation; ECHO, echocardiogram.