Yonsei Med J.  2010 Mar;51(2):151-163. 10.3349/ymj.2010.51.2.151.

Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings

• Tsai SH
• Lin YY
• Chu SJ
• Hsu CW
• Cheng SM

• KMID: 1126012
• DOI: http://doi.org/10.3349/ymj.2010.51.2.151

Abstract

Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF). The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea. Nevertheless, elevated NPs levels can be found in many circumstances involving left ventricular (LV) dysfunction or hypertrophy; right ventricular (RV) dysfunction secondary to pulmonary diseases; cardiac inflammatory or infectious diseases; endocrinology diseases and high output status without decreased LV ejection fraction. Even in the absence of significant clinical evidence of volume overload or LV dysfunction, markedly elevated NP levels can be found in patients with multiple comorbidities with a certain degree of prognostic value. Potential clinical applications of NPs are expanded accompanied by emerging reports regarding screening the presence of secondary cardiac dysfunction; monitoring the therapeutic responses, risk stratifications and providing prognostic values in many settings. Clinicians need to have expanded knowledge regarding the interpretation of elevated NPs levels and potential clinical applications of NPs. Clinicians should recognize that currently the only reasonable application for routine practice is limited to differentiation of acute dyspnea, rule-out-diagnostic-tests, monitoring of therapeutic responses and prognosis of acute or decompensated CHF. The rationales as well the potential applications of NPs in these settings are discussed in this review article.

Keyword

Natriuretic peptides; acute coronary syndrome; cardiac dysrhythmia; pulmonary embolism; pulmonary hypertension; hyperthyroidism; cirrhosis of liver; renal failure; sepsis; stroke; carbon monoxide intoxication

MeSH Terms

Acute Coronary Syndrome/metabolism
Arrhythmias, Cardiac/metabolism
Heart Failure/*metabolism
Humans
Hypertension, Pulmonary/metabolism
Natriuretic Peptides/*metabolism
Sepsis/metabolism

Figure

• 

  Fig. 1 The causes and mechanisms of elevated natriuretic peptides levels. *The main reason of elevated natriuretic peptides and the best-established use of these testing. Circumstances in the example list may share more than one mechanism.

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