[Natriuretic peptides--when should they be used in heart failure?]

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are widely being used as biomarkers in acute and chronic heart failure. These cardiac neurohormones are mainly being secreted from the left and right ventricles as a response to ventricular volume expansion, pressure overload and resultant increased wall tension.

Current application of natriuretic peptides is manifold. BNP and NT-proBNP are being used as screening parameters, diagnostic markers, and prognostic indicators or to monitor therapy. However, their usage to diagnose heart failure and possibly in future adjust therapy should not be uncritical.

In the interpretation of natriuretic peptides it has to be considered that several factors such as age, sex, constitution and non-cardiac diseases like renal failure influence plasma levels. Natriuretic peptides may support diagnostics of heart failure in patients with unexplained dyspnea. However, biomarkers should not be used to replace conventional clinical evaluation. The use of natriuretic peptides for screening asymptomatic populations is inappropriate. A BNP-guided titration of heart failure medication is not yet warranted. BNP testing may be used only in selected situations for risk stratification since the prognostic value is still limited by a lack of clear usefulness in guiding clinical management.

The measurement of natriuretic peptides is at present largely an addition in the diagnosis of acute heart failure, as long as possible errors in interpretation are taken into account.