Natriuretic peptides in coronary disease with non-ST elevation: new tools ready for clinical application?

Natriuretic peptides (BNP and pro-BNP) represent useful biomarkers in heart failure diagnosis and risk stratification, more recently their clinical use has been applied in Acute Coronary Syndrome (ACS) with and without ST elevation. Few studies demonstrated that hormones dosage could add clinical and prognostic information respect to the traditional laboratory analysis (i.e. Troponin, MB-creatinkinase, C-reactive protein). In fact, natriuretic peptides appear able to predict left ventricular enlargement and dysfunction after coronary episode and high plasma levels seem related to future cardiac events and poor prognosis at early and late time. Therefore, data from both experimental and clinical studies suggest that BNP and pro-BNP levels may reflect the size and severity of the ischemic insult, even in the absence of myocardial necrosis. On the basis of these reports, we describe below the potential clinical application and prognostic information of natriuretic peptides in patients affected to non-ST elevation coronary disease. Some recent patents discuss the role of cardiac hormones, especially focus on natriuretic peptide for the treatment of acute coronary syndrome.