Cardiac Hormones as Diagnostic Tools in Heart Failure
Heikki Ruskoaho
Department of Pharmacology and Toxicology, Biocenter Oulu, FIN-90014 University of Oulu, Finland
Correspondence: Address all correspondence and requests for reprints to: Heikki Ruskoaho, M.D., Ph.D., Department of Pharmacology and Toxicology, Faculty of Medicine, University of Oulu, P.O. Box 5000 (Aapistie 5), FIN-90014 University of Oulu, Finland. E-mail: heikki.ruskoaho{at}oulu.fi
In patients with heart failure, plasma levels of atrial natriureticpeptide (ANP), B-type natriuretic peptide (BNP), and the N-terminalfragments of their prohormones (N-ANP and N-BNP) are elevated,because the cardiac hormonal system is activated by increasedwall stretch due to increased volume and pressure overload.Patients suspected of having heart failure can be selected forfurther investigations on the basis of having an elevated plasmaconcentration of N-ANP, BNP, and N-BNP. High levels of cardiachormones identify those at greatest risk for future seriouscardiovascular events. Moreover, adjusting heart failure treatmentto reduce plasma levels of N-BNP may improve outcome. Cardiachormones are most useful clinically as a rule-out test. In acutelysymptomatic patients, a very high negative predictive valueis coupled with a relatively high positive predictive value.Measurement of cardiac hormones in patients with heart failuremay reduce the need for hospitalizations and for more expensiveinvestigations such as echocardiography. However, there havealso been conflicting reports on the diagnostic value of cardiachormones, they are not specific for any disease, and the magnitudeof the effects of age and gender on BNP in the normal subgroupsuggests that these parameters need to be considered when interpretingcardiac hormone levels.
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