Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations

European Journal of Heart Failure - Tập 21 Số 6 - Trang 715-731 - 2019
Christian Mueller1, Kenneth McDonald2, Rudolf A. de Boer3, Alan S. Maisel4, John G.F. Cleland5, Nikola Kozhuharov1, Andrew J.S. Coats6,7,8, Marco Metra9, Alexandre Mebazaa10, Frank Ruschitzka11, Mitja Lainščak12,13, Gerasimos Filippatos14,15, Petar Seferović16, Wouter C. Meijers3, Antoni Bayés‐Genís17,18, Thomas Mueller19, Mark Richards20,21, James L. Januzzi22
1Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
2Department of Cardiology, St. Vincent’s University Hospital, Dublin, Ireland
3University of Groningen, University Medical Center Groningen, Department of Cardiology, The Netherlands
4University of California, San Diego, CA, USA
5Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
6Monash University, Melbourne, Australia
7Pharmacology, Centre of Clinical and Experimental Medicine, San Raffaele Pisana Scientific Institute, Rome, Italy
8University of Warwick, Coventry, UK
9Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
10Université de Paris, APHP Département d'Anethésie‐Réanimation Hôpitaux Universitaires Saint Louis Lariboisière Paris France
11Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
12Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia
13Faculty of Medicine, University of Ljubljana, Slovenia
14Department of Cardiology, Athens University Hospital Attikon, University of Athens, Greece
15University of Cyprus Medical School, Nicosia, Cyprus
16Faculty of Medicine, University of Belgrade, Belgrade, Serbia
17Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
18Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Barcelona, Spain
19Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
20Cardiovascular Research Institute, National University of Singapore, Singapore
21Christchurch Heart Institute, Uinversity of Otago, New Zealand
22Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Tóm tắt

Natriuretic peptide [NP; B‐type NP (BNP), N‐terminal proBNP (NT‐proBNP), and midregional proANP (MR‐proANP)] concentrations are quantitative plasma biomarkers for the presence and severity of haemodynamic cardiac stress and heart failure (HF). End‐diastolic wall stress, intracardiac filling pressures, and intracardiac volumes seem to be the dominant triggers. This paper details the most important indications for NPs and highlights 11 key principles underlying their clinical use shown below. NPs should always be used in conjunction with all other clinical information. NPs are reasonable surrogates for intracardiac volumes and filling pressures. NPs should be measured in all patients presenting with symptoms suggestive of HF such as dyspnoea and/or fatigue, as their use facilitates the early diagnosis and risk stratification of HF. NPs have very high diagnostic accuracy in discriminating HF from other causes of dyspnoea: the higher the NP, the higher the likelihood that dyspnoea is caused by HF. Optimal NP cut‐off concentrations for the diagnosis of acute HF (very high filling pressures) in patients presenting to the emergency department with acute dyspnoea are higher compared with those used in the diagnosis of chronic HF in patients with dyspnoea on exertion (mild increase in filling pressures at rest). Obese patients have lower NP concentrations, mandating the use of lower cut‐off concentrations (about 50% lower). In stable HF patients, but also in patients with other cardiac disorders such as myocardial infarction, valvular heart disease, atrial fibrillation or pulmonary embolism, NP concentrations have high prognostic accuracy for death and HF hospitalization. Screening with NPs for the early detection of relevant cardiac disease including left ventricular systolic dysfunction in patients with cardiovascular risk factors may help to identify patients at increased risk, therefore allowing targeted preventive measures to prevent HF. BNP, NT‐proBNP and MR‐proANP have comparable diagnostic and prognostic accuracy. In patients with shock, NPs cannot be used to identify cause (e.g. cardiogenic vs. septic shock), but remain prognostic. NPs cannot identify the underlying cause of HF and, therefore, if elevated, must always be used in conjunction with cardiac imaging.

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European Journal of Heart Failure

Tập 21 Số 6

715-731

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