N-Terminal ProBNP: Marker of Systolic Dysfunction or Nonspecific Indicator of Cardiac Disease?

摘要

The clinical diagnosis of heart failure may represent a considerable challenge, particularly in the obese, in women and in the elderly. Because contemporary heart failure therapy has been shown to significantly reduce mortality and the number of hospital readmissions, an early and correct diagnosis is crucial. The cost and potential side effects associated with heart failure therapy also means that overtreatment should best be avoided.The clinical syndrome of chronic congestive heart failure is often the end stage of progressive left ventricular dysfunction and is commonly preceded by an asymptomatic or oligosymptomatic latent phase. Congestive heart failure is frequently caused by systolic dysfunction of the left ventricle, but a considerable proportion of patients do have preserved systolic function. Echocardiography is routinely performed by cardiologists to establish the diagnosis of impaired left ventricular systolic function, but this method requires expensive equipment and skilled operators and is not always readily available. During the past few years, B-type natriuretic peptide (BNP) and the N-terminal fragment of its prohormone, N-terminal proBNP (NT-proBNP) have emerged as promising markers of ventricular dysfunction, and biochemical tests for rapid measurement of these substances have been developed. A point-of-care test for rapid analysis of BNP was first introduced in the year 2000. Very recently, fully automated analytic systems for the determination of BNP and NT-proBNP on large hospital platforms have also become commercially available.