Natriuretic peptides in assessment of left-ventricular dysfunction

The heart secrets two different natriuretic peptides, atrial natriuretic pe ptide (ANP) and brain natriuretic peptide (BNP), which have potent vasorela xant, diuretic, and natriuretic actions. They are main tools in the body's defense against volume overload and hypertension. The natriuretic peptides (NP) are synthetized as prohormones. The C-terminal endocrinological active peptides and their N-terminal prohormone fragments are found in plasma. Th e NP system is maximally activated in ventricular dysfunction. However, NP: s are also increased in patients with renal failure or pulmonary hypertensi on, and increases may be found in arterial hypertension or liver cirrhosis. Among all NP and prohormone fragments currently BNP is the most promising candidate analyte for routine diagnosis. BNP is also superior to other neur ohormones for diagnosis of left-ventricular dysfunction (LVD) or estimating prognosis in LVD or during the subacute phase of myocardial infarction. Fo r primary care physicians BNP measurement is useful to decide which patient with suspected heart failure warrants further investigation, particularly when assessment of left ventricular function is not readily available. BNP has an excellent negative predictive value particularly in high risk patien ts. For the cardiologists the NP:s are helpful for monitoring therapy and d isease course in LVD patients and for estimating prognosis in LVD and myoca rdial infarction patients. There is now sufficient evidence to encourage ph ysicians to gain experience with NP as a supplement in the diagnosis of pat ients suspected of having heart failure. An increase in BNP is serious enou gh to warrant follow-up examinations.