The Reign of the Natriuretic Peptides in Patients with Heart Failure Continues

B-type natriuretic peptides are consistently shown to be more powerful prognostic markers than their traditional counterparts...'It was encouraging to see that there were several sessions dedicated to biomarkers at the annual meeting of the European Society of Cardiology (ESC) in September 2008, particularly in relation to patients with heart failure.However, the large number of novel markers currently being investigated in this field only highlights our rudimentary understanding of the complex interaction of the neurohormonal systems involved.Still, the diagnostic and prognostic power of some of these biomarkers is without question, and despite this (like many successes in clinical studies) they are slow to be adopted into standard clinical practice.This is particularly true of the B-type natriuretic peptides (BNPs) [1].Discovered 20 years ago [2], the BNPs are now well known to be increased in both asymptomatic and symptomatic left ventricular systolic dysfunction (LVSD), rising in proportion to the severity of chronic heart failure [3][4][5].BNP can accurately detect LVSD in the general population [6], but it is particularly useful as a 'rule-out' test owing to its high negative predictive value.As such, the BNPs are now recommended by the ESC [7] and American College of Cardiology/American Heart Association [8] for the diagnosis of both acute and chronic heart failure.