Abstract
Natriuretic peptides (NPs) have become important diagnostic and prognostic biomarkers in cardiovascular diseases, particularly in heart failure (HF). Diagnosis and management of coronary artery disease and atrial fibrillation (AF) can also be guided by NP levels. When interpreting NP levels, however, the caveat is that age, sex, body mass index, renal dysfunction, and race affect the clearance of NPs, resulting in different cut-off values in clinical practice. In AF, NP levels have been associated with incident AF in the general population, recurrences after catheter ablation, prediction of clinical prognosis, and the risk of stroke. In this article, we first review and summarize the current evidence and the roles of B-type NP and atrial NP in HF and coronary artery disease and then focus on the increasing utility of NPs in the diagnosis and management of and the research into AF.
Highlights
Natriuretic peptide (NP) levels are widely measured in clinical practice and have been extensively assessed in cardiovascular research throughout the world
The PRIDE study applying NT-proBNP levels showed similar findings among 600 patients presenting to the emergency department (ED) with dyspnea, in which the cut-off level was set at 300 pg/mL, at 90% sensitivity and 85% specificity for the diagnosis of acute heart failure (HF) [1]
The BACH study including 1445 patients with acute dyspnea showed that the diagnostic performance of B-type natriuretic peptide (BNP) and NT-proBNP for acute HF was impaired by the presence of atrial fibrillation (AF) [81] (Figure 3)
Summary
Natriuretic peptide (NP) levels are widely measured in clinical practice and have been extensively assessed in cardiovascular research throughout the world. B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are the most commonly used to diagnose heart failure (HF) [1,2,3]. Diagnosis and management of acute coronary syndrome (ACS) [4,5] and atrial fibrillation (AF) [6] can be guided by NP levels. We first review and summarize the current evidence and roles of BNP and atrial natriuretic peptide (ANP) in HF and ACS and focus on the increasing utility of NPs in the diagnosis and management of and research into AF from the viewpoint of electrophysiologists routinely performing catheter ablation of AF
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