Hellenkamp K, von Haehling S
Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Internist (Berl). 2019 Jun;60(6):587-596. doi: 10.1007/s00108-019-0606-7.
Biomarkers may help to rapidly differentiate heart failure from noncardiac causes of acute dyspnea. Natriuretic peptides are especially useful for this purpose and should be measured in all patients presenting with acute onset dyspnea. Due to their excellent negative predictive value, a normal serum concentration of natriuretic peptides makes acute heart failure unlikely. Assays exist for B‑type natriuretic peptide (BNP), N‑terminal pro-B-type natriuretic peptide (NT-proBNP) and midregional pro-atrial natriuretic peptide (MR-proANP) with established cut-offs in the acute setting. Importantly, in patients treated with an angiotensin receptor-neprilysin inhibitor (ARNI), NT-proBNP (or MR-proANP) should be used instead of BNP, since the latter is increased by ARNI treatment. Besides their established diagnostic value in heart failure patients, the measurement of natriuretic peptides provides prognostic information and may help in guiding therapy. Additionally, multiple other biomarkers reflect several pathophysiological processes involved in heart failure patients. Their diagnostic and prognostic impact in heart failure needs to be established.
生物标志物可能有助于快速区分心力衰竭与急性呼吸困难的非心脏病因。利钠肽在此方面特别有用，所有急性起病呼吸困难的患者均应检测利钠肽。由于其出色的阴性预测价值，利钠肽血清浓度正常时急性心力衰竭的可能性不大。目前存在检测B型利钠肽（BNP）、N末端B型利钠肽原（NT-proBNP）和中段心房利钠肽原（MR-proANP）的检测方法，且在急性情况下有既定的临界值。重要的是，在接受血管紧张素受体脑啡肽酶抑制剂（ARNI）治疗的患者中，应使用NT-proBNP（或MR-proANP）而非BNP，因为ARNI治疗会使后者升高。除了在心力衰竭患者中已确立的诊断价值外，利钠肽的检测还能提供预后信息并有助于指导治疗。此外，还有多种其他生物标志物反映了心力衰竭患者所涉及的多种病理生理过程。它们对心力衰竭的诊断和预后影响有待确定。
