B-type natriuretic peptide: a critical review.

Natriuretic peptides have been used as tools for diagnosis and risk stratification in patients with heart failure, myocardial infarction, and unstable coronary syndromes, as well as in the general population. The biology of intra-assay and intraindividual variations of plasma natriuretic peptide levels is still not clearly understood despite their broad adoption in clinical practice. Interpretation of plasma natriuretic peptide levels therefore requires availability of the clinical context as well as considerations of various confounders. It is clear that high plasma natriuretic peptide levels can be highly suggestive of underlying myocardial disease, although a specific underlying cause cannot be identified based on the test results. The potential use of natriuretic peptide levels to monitor and guide patient management or detect subclinical disease states is currently under investigation.