STATE-OF-THE-ART PAPER
Natriuretic Peptides
Lori B. Daniels, MD* and
Alan S. Maisel, MD, FACC
Division of Cardiology, University of California at San Diego, and the Division of Cardiology, Veteran's Affairs San Diego Healthcare System, San Diego, California
Manuscript received July 31, 2007;
revised manuscript received September 10, 2007,
accepted September 26, 2007.
* Reprint requests and correspondence: Dr. Lori B. Daniels, Division of Cardiology, University of California, San Diego, MC 0986, 9350 Campus Point Drive, Suite 1D, La Jolla, California 92037-1300. (Email: loridaniels{at}ucsd.edu).
Natriuretic peptides (NPs) are released from the heart in response to pressure and volume overload. B-type natriuretic peptide (BNP) and N-terminal-proBNP have become important diagnostic tools for assessing patients who present acutely with dyspnea. The NP level reflects a compilation of systolic and diastolic function as well as right ventricular and valvular function. Studies suggest that using NPs in the emergency department can reduce the consumption of hospital resources and can lower costs by either eliminating the need for other, more expensive tests or by establishing an alternative diagnosis that does not require hospital stay. Caveats such as body mass index and renal function must be taken into account when analyzing NP levels. Natriuretic peptide levels have important prognostic value in multiple clinical settings, including in patients with stable coronary artery disease and with acute coronary syndromes. In patients with decompensated heart failure due to volume overload, a treatment-induced drop in wedge pressure is often accompanied by a rapid drop in NP levels. Knowing a patient's NP levels might thus assist with hemodynamic assessment and subsequent treatment titration. Monitoring NP levels in the outpatient setting might also improve patient care and outcomes.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | ANP = atrial natriuretic peptide | | AUC = area under the receiver-operating characteristic curve | | BNP = B-type natriuretic peptide | | CAD = coronary artery disease | | CHF = congestive heart failure | | ED = emergency department | | GFR = glomerular filtration rate | | HF = heart failure | | LV = left ventricle/ventricular | | MI = myocardial infarction | | NP = natriuretic peptide | | NPR = natriuretic peptide receptor | | NTproBNP = amino-terminal fragment of B-type natriuretic peptide | | NYHA = New York Heart Association |
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