The Role of Natriuretic Peptides in Pericardial Fluid in Predicting Cardiovascular Disorders: A Systematic Review

Atrial and ventricular natriuretic peptides play an important role in the neurohormonal regulation of cardiac function. Plasma levels of these peptides may aid in the diagnosis and prognosis of different cardiac disorders, such as congestive heart failure, ischemic heart disease, and atrial fibrillation. However, the association between elevated pericardial fluid levels of natriuretic peptides and these clinical conditions has not been proven. Databases Medline, EMBASE, Cochrane, ClinicalTrials.gov, and Google Scholar were searched for primary studies evaluating atrial natriuretic peptide, B-type natriuretic peptide, and N-terminal-pro-B-type natriuretic peptide concentrations within the pericardial fluid in various cardiac disorders. A total of 1060 citations were screened, of which 38 studies underwent a full-text evaluation, and 10 were finally included in this review. Sample size varied across studies (n = 8-148), and there was a total of 577 patients across the 10 studies. Findings suggested that pericardial fluid levels of B-type natriuretic peptide and N-terminal-pro-B-type natriuretic peptide but not atrial natriuretic peptide, may correlated with the reported cardiac conditions. Our findings suggest that pericardial fluid levels of natriuretic peptides may correlate with some cardiac disorders such as congestive heart failure and atrial fibrillation. The addition of these peptides to the existing clinical risk stratification scores may be helpful in the early diagnosis and management of these conditions.