3 2
Diagnosis
Table 1. Selected Potential Causes of Elevated Natriuretic
Peptide Levels (2017)
Cardiac
• HF, including RV syndromes
• Acute coronary syndromes
• Heart muscle disease, including LVH
• Valvular heart disease
• Pericardial disease
• Atrial fibrillation
• Myocarditis
• Cardiac surgery
• Cardioversion
• Toxic-metabolic myocardial insults, including cancer chemotherapy
Noncardiac
• Advancing age
• Anemia
• Renal failure
• Pulmonary: obstructive sleep apnea, severe pneumonia
• Pulmonary hypertension
• Critical illness
• Bacterial sepsis
• Severe burns
Table 2. Biomarkers for Prevention (2017)
COR
LOE Recommendation
IIa B-R For patients at risk of developing HF, natriuretic peptide
biomarker–based screening followed by team-based care, including a
cardiovascular specialist optimizing GDMT, can be useful to prevent
the development of le ventricular dysfunction (systolic or diastolic)
or new-onset HF.
Table 3. Biomarkers for Diagnosis (2017)
COR
LOE Recommendation
I A In patients presenting with dyspnea, measurement of natriuretic peptide
biomarkers is useful to support a diagnosis or exclusion of HF.
Table 4. Biomarkers for Prognosis or Added Stratification
(2017)
COR
LOE Recommendations
I A Measurement of BNP or NT-proBNP is useful for establishing
prognosis or disease severity in chronic HF.
I A Measurement of baseline levels of natriuretic peptide biomarkers and/
or cardiac troponin on admission to the hospital is useful to establish a
prognosis in acutely decompensated HF.
IIa B-NR During a HF hospitalization, a predischarge natriuretic peptide level
can be useful to establish a postdischarge prognosis.
IIb B-NR In patients with chronic HF, measurement of other clinically available
tests, such as biomarkers of myocardial injury or fibrosis, may be
considered for additive risk stratification.
