State-of-the-Art Paper
Natriuretic Peptides

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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.

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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This work is supported in part by a Western States Affiliate Post-Doctoral Award from the American Heart Association (to Dr. Daniels). Dr. Daniels has received research funding from Roche. Dr. Maisel has received research funding from Bayer, Abbott, and Roche and has served as a paid consultant for Biosite. James de Lemos, MD, served as Guest Editor for this article.