B-type natriuretic peptides in heart failure: update on clinical applications and limitations

Heart failure remains an important clinical and public health problem with significant mortality, morbidity and economic consequences. The identification of natriuretic peptides and the large number of investigations that followed have led to a better understanding of the neurohormonal pathophysiology of heart failure. The clinical usefulness of natriuretic peptides in heart failure diagnosis, prognosis and treatment guidance remains to be fully clarified but B-type natriuretic peptides and N-terminal pro-BNP appear to have an emerging role. Like any clinical test, the usefulness of natriuretic peptides measurements depends upon appropriate use and recognition of limitations. This review focuses on these issues.