Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings.
10.3349/ymj.2010.51.2.151
- Author:
Shih Hung TSAI
1
;
Yen Yue LIN
;
Shi Jye CHU
;
Ching Wang HSU
;
Shu Meng CHENG
Author Information
1. Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. doc50024@ndmctsgh.edu.tw
- Publication Type:Review
- Keywords:
Natriuretic peptides;
acute coronary syndrome;
cardiac dysrhythmia;
pulmonary embolism;
pulmonary hypertension;
hyperthyroidism;
cirrhosis of liver;
renal failure;
sepsis;
stroke;
carbon monoxide intoxication
- MeSH:
Acute Coronary Syndrome/metabolism;
Arrhythmias, Cardiac/metabolism;
Heart Failure/*metabolism;
Humans;
Hypertension, Pulmonary/metabolism;
Natriuretic Peptides/*metabolism;
Sepsis/metabolism
- From:Yonsei Medical Journal
2010;51(2):151-163
- CountryRepublic of Korea
- Language:English
-
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.
