Natriuretic Peptide Applications in Heart Failure Management and Diagnosis

Natriuretic peptides, principally B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP), are cardiac‐derived hormones released in response to ventricular wall stress. They promote natriuresis, vasodilation, inhibition of the renin–angiotensin–aldosterone system and sympathetic tone, thereby counteracting maladaptive remodelling in heart failure. Clinically, measurement of circulating BNP and NT-proBNP has become indispensable for diagnosis, risk stratification and monitoring of therapeutic response. Low‐threshold natriuretic peptide levels reliably exclude heart failure, while elevated values correlate with severity and prognosis. Beyond diagnostic algorithms, serial assessment guides therapy by signalling inadequate decongestion or escalating cardiac strain. Emerging applications harness natriuretic peptide biology to refine personalised management, including tailored pharmacotherapy, device timing and integration into point-of-care platforms. Advances in assay specificity and understanding of peptide processing continue to expand their utility in both acute and chronic heart failure settings.

Research from Nature Portfolio

A recent development has focussed on combining NT-proBNP measurements with clinical variables into a composite risk score that outperforms conventional prognostic indices for in-hospital mortality in acute heart failure. This score integrates an NT-proBNP threshold above 8 100 pg/mL, advanced age, lack of guideline‐directed therapies (such as renin–angiotensin inhibitors and beta-blockers), and markers of haemodynamic compromise (mechanical support, vasopressor use, resuscitation). The approach has demonstrated superior discrimination and net reclassification, offering clinicians a robust tool for early identification of high-risk patients and optimisation of care pathways.

Natriuretic Peptide Applications in Heart Failure Management and Diagnosis publication trend

The graph below shows the total number of articles in natriuretic peptide applications in heart failure management and diagnosis across all publications each year (not limited to Nature Index journals).

Technical terms

Natriuretic peptides: A family of cardiac hormones (ANP, BNP) that regulate blood volume and pressure by promoting sodium excretion and vasodilation.

BNP (B-type natriuretic peptide): A 32-amino-acid hormone produced by ventricular myocytes in response to stretch; used as a biomarker for heart failure.

NT-proBNP (N-terminal pro-B-type natriuretic peptide): The inert N-terminal fragment of the BNP precursor, released in equimolar amounts to BNP and measured for diagnostic and prognostic purposes.

Sacubitril/valsartan: A combination neprilysin inhibitor and angiotensin receptor blocker that raises endogenous natriuretic peptide levels and improves outcomes in heart failure.

Autophagy: A cellular process for degrading and recycling damaged organelles or proteins, essential for maintaining cardiomyocyte homeostasis under stress.

Mitophagy: A selective form of autophagy targeting dysfunctional mitochondria for removal, crucial for mitochondrial quality control in heart failure.

References

1. Atrial natriuretic peptide stimulates autophagy/mitophagy and improves mitochondrial function in chronic heart failure. Cellular and Molecular Life Sciences (2023).
2. Towards Point-of-Care Heart Failure Diagnostic Platforms: BNP and NT-proBNP Biosensors. Sensors (2019).
3. N-terminal pro b-type natriuretic peptide (NT-pro-BNP) –based score can predict in-hospital mortality in patients with heart failure. Scientific Reports (2016).