State of the art: Using natriuretic peptide levels in clinical practice

Alan Maisel*, Christian Mueller, Kirkwood Adams, Stefan D. Anker, Nadia Aspromonte, John G F Cleland, Alain Cohen-Solal, Ulf Dahlstrom, Anthony DeMaria, Salvatore Di Somma, Gerasimos S. Filippatos, Gregg C. Fonarow, Patrick Jourdain, Michel Komajda, Peter P. Liu, Theresa McDonagh, Kenneth McDonald, Alexandre Mebazaa, Markku S. Nieminen, W. Frank PeacockMarco Tubaro, Roberto Valle, Marc Vanderhyden, Clyde W. Yancy, Faiez Zannad, Eugene Braunwald

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

709 Scopus citations


Natriuretic peptide (NP) levels (B-type natriuretic peptide (BNP) and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research throughout the world and have been incorporated into most national and international cardiovascular guidelines for heart failure. The role of NP levels in state-of-the-art clinical practice is evolving rapidly. This paper reviews and highlights ten key messages to clinicians:•NP levels are quantitative plasma biomarkers of heart failure (HF).•NP levels are accurate in the diagnosis of HF.•NP levels may help risk stratify emergency department (ED) patients with regard to the need for hospital admission or direct ED discharge.•NP levels help improve patient management and reduce total treatment costs in patients with acute dyspnoea.•NP levels at the time of admission are powerful predictors of outcome in predicting death and re-hospitalisation in HF patients.•NP levels at discharge aid in risk stratification of the HF patient.•NP-guided therapy may improve morbidity and/or mortality in chronic HF.•The combination of NP levels together with symptoms, signs and weight gain assists in the assessment of clinical decompensation in HF.•NP levels can accelerate accurate diagnosis of heart failure presenting in primary care.•NP levels may be helpful to screen for asymptomatic left ventricular dysfunction in high-risk patients.

Original languageEnglish (US)
Pages (from-to)824-839
Number of pages16
JournalEuropean Journal of Heart Failure
Issue number9
StatePublished - Sep 2008


  • Clinical practice
  • Diagnosis
  • Natriuretic peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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