Affiliations: Section of Cardiology, Glostrup University Hospital,
Denmark
Note: [] Per Hildebrandt, Section of Cardiology, Glostrup University
Hospital, Nordre Ringvej, DK-2650 Glostrup, Denmark. Tel.: +45 27 13 54 26;
E-mail: [email protected]
Abstract: The natriuretic peptides, especially the B-type peptide (BNP) and
its inactive split-product N-terminal proBNP (Nt-proBNP) are increasingly used
in screening for heart failure, primarily with reduced systolic function, in
patients with symptoms suggestive of heart failure, as well in the stable
(General Practitioner) setting as in the acute setting. Supporting this use is
a very strong prognostic value of the natriuretic peptides. This has been shown
in as well heart failure as acute coronary syndromes, but also in the general
population and in high-risk groups as patients with diabetes, hypertension and
coronary artery disease. This has of course raised interest for the use of the
natriuretic peptides as a risk marker and for screening for heart failure with
reduced systolic function in these populations. In symptomatic persons and in
high risk populations, the natriuretic peptides have demonstrated a high
sensitivity for ruling out the disease, if the right decision limits are
choosen. Thus the number of normal echocardiographies can be reduced. More recently, the use in screening asymptomatic persons for left ventricular
systolic dysfunction has gained more interest. In the unselected population,
screening would probably not be cost-effective. In populations with a higher
pre-test probability for heart failure, as patients with diabetes, hypertension
and stable coronary artery disease, screening would presumably be more
cost-effective, but evidence for the use in this setting is still lacking.
