Use of NT-proBNP for the screening, diagnosis and risk-stratification of left ventricular dysfunction

Area of Science:

• Cardiology
• Biomarkers
• Preventive Medicine

Background:

• Heart failure (HF) poses a significant global health burden.
• Early detection of left ventricular dysfunction can prevent HF onset with therapies like ACE inhibitors and beta-blockers.
• Echocardiography screening is expensive, necessitating alternative methods.

Purpose of the Study:

• To evaluate the feasibility of using natriuretic peptides for screening asymptomatic left ventricular dysfunction and HF.
• To identify the need for optimized natriuretic peptide thresholds considering demographic and clinical factors.
• To assess the role of natriuretic peptides in risk stratification for cardiovascular events in high-risk populations like those with diabetes.

Main Methods:

• Review of existing studies on natriuretic peptide screening for asymptomatic left ventricular dysfunction.
• Analysis of factors influencing natriuretic peptide levels, including age, sex, and comorbidities (atrial fibrillation, kidney disease).
• Consideration of current guidelines for HF diagnosis and diabetes management.

Main Results:

• Natriuretic peptides offer a potentially cost-effective screening method compared to echocardiography.
• Natriuretic peptide levels exhibit variability based on age, sex, and comorbidities, impacting diagnostic accuracy with single thresholds.
• High-yield screening strategies involve targeting high-risk populations, such as individuals with diabetes mellitus.
• Natriuretic peptides are integral to HF definition and risk assessment in diabetic patients.

Conclusions:

• Natriuretic peptides are a viable tool for screening asymptomatic left ventricular dysfunction and HF.
• Further research is required to establish optimal, individualized thresholds for natriuretic peptides, accounting for age, sex, body weight, and comorbidities.
• Clinicians should utilize guideline-recommended thresholds while considering individual patient factors influencing natriuretic peptide levels for accurate HF diagnosis.
• The utility of natriuretic peptides in guiding HF management remains an area for future investigation.