Natriuretic peptide testing in primary care patients

Abstract

The evaluation of cardiac endocrine function by means of automated robust assays has permitted the introduction of a cheap and powerful clinical tool. Plasma concentration of B-type-related natriuretic peptides is a marker of either hemodynamic or neurohormonal stress on the heart and has been validated within the diagnostic and prognostic domain in patients with suspected or ascertained heart failure, mostly in the in-hospital setting. Evidence is growing, supporting an out-of-hospital use, namely in primary care. Its implementation in this setting in screening programs and diagnostic algorithms might contribute to decrease the apparent disparity between the general practitioner and the specialist approach to disease management.

Recent advances on natriuretic peptide system: New promising therapeutic targets for the treatment of heart failure

“…5). These findings represent the rationale for evaluating the diagnostic accuracy of BNP and NT-proBNP levels in screening programs including general population or primary care patients [51,52]. Moreover, some recent studies reported that patient with heart failure have also greatly increased circulating proBNP levels compared to healthy subjects [22,[26][27][28].…”

Natriuretic Peptide Assays Revisited

“…The widespread diffusion of automated assays of BNP and NT-proBNP has furnished a novel tool for diagnosis, prognostic evaluation, and guide to treatment of overt HF, as well for the screening of asymptomatic left ventricular dysfunction in the general population (2,7), with a potential use in primary care (8). Recent evidence has challenged, however, the specificity of all commercial assays for BNP and NT-proBNP, indicating a significant cross-reactivity with the precursor proBNP 1-108 , variable for each assay (9).…”

“…tomatic subjects at intermediate to high risk for HF, or for differential diagnosis in patients with dyspnea. Evidence is growing, supporting an out-of-hospital use of natriuretic peptide assays: their implementation in screening programs and diagnostic algorithms in primary care might contribute to decrease the apparent disparity between the general practitioner and the specialist approach to disease management (8).…”