Are Natriuretic Peptides Clinically Useful as Markers of Heart Failure?

Heart failure is a clinical syndrome of signs and symptoms caused by left ventricular dysfunc­ tion. It is the most serious expression of heart disease and encompasses a wide spectrum of pathophysiological states, ranging from those caused by sudden impairment of pump function (e.g. massive myocardial infarction) to the progressive and gradual impairment of myo­ cardial function, for example in patients whose heart is subjected to pressure or volume over­ load, or who have a chronic disorder of the heart muscle. In practical terms heart failure is diagnosed when symptoms of breathlessness (at rest or on exertion) or fatigue and signs of fluid retention (peripheral oedema, pulmonary crepitations or elevated jugular venous pressure) are found in a patient already suspected of having heart disease. Cardiac dysfunction is an essential element in the diagnosis of heart failure. The commonest cause is left ventricular systolic dysfunction (LVSD) due to myocardial disease. The syndrome of heart failure is primarily cardiac, but secondary multisystem dysfunction often follows, leading to a terminal state of multiorgan failure.