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Education in Heart
Biomarkers in heart failure: a focus on natriuretic peptides
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  • Published on: 10 May 2024
    Limitations of biomarkers in heart failure with preserved ejection fraction and in mimics of that syndrome

    The assertion that natriuretic peptide levels below a defined threshold(for, example, Brain Natriuretic Peptide(BNP) levels < 100 pg/mL) can safely rule out heart failure and may also obviate the need to proceed to early echocardiography[1] should be qualified as follows:-
    Early echocardiography does not necessarily confirm or refute the diagnosis of congestive heart failure(CHF) in patients with heart failure characterised by preserved ejection fraction(HFpEF). This is a truism that ought to be valid even in HFpEF patients with BNP levels < 100 pg/mL[2]. In the latter study , among 159 patients who had been hospitalised for CHF, the latter characterised by left ventricular ejection fraction(LVEF) amounting to >50%, in association with pulmonary capillary wedge pressure > 15 mm Hg, 46/159 patients(29%) had BNP equal to or less than 100 pg/mL[2].. Accordingly, if the index of suspicion for CHF is sufficiently high strategies other than echocardiography should be deployed to confirm or refute the diagnosis of CHF. The following are some of those strategies:-
    (i) Clinical evaluation of jugular venous pressure(JVP). A raised JVP is indicative of a right atrial pressure beyond the normal upper limit of 8 mm Hg[3]. Furthermore, jugular venous distension is associated with a likelihood ratio amounting to 5.1(95% Confidence Interval, 3.2 to 7.9) in favour of a diagnosis of CHF[4].
    (ii)Evaluation of inferior vena cava(IVC) diameter. An...

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    Conflict of Interest:
    None declared.