Natriuretic Peptides in Clinical Practice

Abstract

Natriuretic peptides (NP) are commonly used diagnostic biomarkers in heart failure (HF). While the American HF guideline strongly recommends NPs as class I indication with the level of evidence A in the diagnosis of both acute and chronic HF (1), the European HF guideline recommends them as class I indicationwith the level of evidence A for acute HF and as class IIa indication with the level of evidence C for chronic HF (2). Similarly, NPs have been proven to be strong biomarkers for prognosis and risk assessment in HF. The American HF guideline recommends NPs as class I indication with the level of evidence A in the assessment of prognosis of both acute and chronic HF (1). Moreover, the American HF guideline recommends NP monitorization as class IIa indication with the level of evidence B for achieving optimal treatment target in chronic HF (1). However, it Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure. Recent heart failure guidelines recognize natriuretic peptides as an essential tool in the new diagnostic and therapeutic algorithms. Furthermore, natriuretic peptides are not only used in the diagnosis or prognosis of heart failure, but also these biomarkers are referred to have some potential role in primary prevention, cardio-oncology, advanced heart failure, assessment of response to cardiac resynchronization therapy, pulmonary arterial hypertension, acute coronary syndromes, atrial fibrillation and valvular heart disease. In this article, natriuretic peptides have been reviewed for their updated information and new recommendations in heart failure and also potential role of these biomarkers in the management of various clinical conditions have been addressed in the form of expert opinion based on the available data in the literature.