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

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          Abstract

          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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          Most cited references154

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          2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.

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            Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

            B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension. We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay. The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure. Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea. Copyright 2002 Massachusetts Medical Society.
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              A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure with Preserved Ejection Fraction

              Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging in euvolemic patients with dyspnea, and no evidence-based criteria are available. We sought to develop and then validate noninvasive diagnostic criteria that could be used to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea to guide further testing.
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                Author and article information

                Journal
                European Journal of Heart Failure
                Eur J Heart Fail
                Wiley
                13889842
                June 2019
                June 2019
                June 20 2019
                : 21
                : 6
                : 715-731
                Affiliations
                [1 ]Department of Cardiology and Cardiovascular Research Institute Basel (CRIB); University Hospital Basel, University of Basel; Basel Switzerland
                [2 ]Department of Cardiology; St. Vincent's University Hospital; Dublin Ireland
                [3 ]University of Groningen, University Medical Center; Groningen, Department of Cardiology; The Netherlands
                [4 ]University of California; San Diego CA USA
                [5 ]Robertson Institute of Biostatistics and Clinical Trials Unit; University of Glasgow; Glasgow UK
                [6 ]University of Warwick; Coventry UK
                [7 ]Monash University; Melbourne Australia
                [8 ]Pharmacology, Centre of Clinical and Experimental Medicine, San Raffaele Pisana Scientific Institute; Rome Italy
                [9 ]Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
                [10 ]Université de Paris, APHP Département d'Anethésie-Réanimation Hôpitaux Universitaires Saint Louis Lariboisière; Paris France
                [11 ]Department of Cardiology, University Heart Centre; University Hospital Zurich; Zurich Switzerland
                [12 ]Department of Internal Medicine; General Hospital Murska Sobota; Murska Sobota Slovenia
                [13 ]Faculty of Medicine; University of Ljubljana; Slovenia
                [14 ]Department of Cardiology, Athens University Hospital Attikon; University of Athens; Greece
                [15 ]University of Cyprus; Medical School; Nicosia Cyprus
                [16 ]Faculty of Medicine; University of Belgrade; Belgrade Serbia
                [17 ]Heart Institute; Hospital Universitari Germans Trias i Pujol, CIBERCV; Barcelona Spain
                [18 ]Department of Medicine; Autonomous University of Barcelona; Barcelona Spain
                [19 ]Department of Clinical Pathology; Hospital of Bolzano; Bolzano Italy
                [20 ]Christchurch Heart Institute; Uinversity of Otago; New Zealand
                [21 ]Cardiovascular Research Institute; National University of Singapore; Singapore
                [22 ]Cardiology Division of the Department of Medicine; Massachusetts General Hospital, Harvard Medical School; Boston MA USA
                Article
                10.1002/ejhf.1494
                31222929
                35159737-e845-4caf-a7be-5672205abea4
                © 2019

                http://doi.wiley.com/10.1002/tdm_license_1.1

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