Diagnostic Applications of Natriuretic Peptides in Ischemic Heart Disease

Abstract

Early assessment of patients who have symptoms suggestive of an acute coronary syndrome (ACS) remains a challenge considering the heterogeneity of underlying pathologies and clinical outcomes. The purpose of the early evaluation of these patients is threefold: first, to diagnose or exclude acute myocardial infarction (AMI) second, to identify patients at different risks for future cardiac events; and third, to be able to select appropriate treatment. Currently the initial assessment of these patients is based on the patient’s history, clinical findings, ECG data, and serial testing of biochemical markers of myocardial necrosis, preferably troponin T or I. In the last few years, an increasing number of studies have evaluated the addition of the natriuretic peptides, NT-proBNP and BNP, in the diagnostic and prognostic arsenal for assessment of patients who have a suspected ACS. The studies of the value of natriuretic peptides have also been extended to patients who have stable angina pectoris for detection of significant coronary artery disease (CAD) and for assessment of the long-term risk. NT-proBNP and BNP in the different forms of ischemic heart disease The prognostic value of NT-proBNP and BNP has been evaluated in the full spectrum of ischemic heart disease in a large number of studies. It is striking that the increased mortality associated with elevation of NT-proBNP or BNP is of a similar degree, regardless of type of presentation of the ischemic heart disease.