[Natriuretic peptides in clinical practice].

The natriuretic peptide (NP) system is primarily an endocrine system that maintains fluid and pressure homeostasis in healthy humans. The cardiac NP, ANP (atrial natriuretic peptide) and BNP (brain natriuretic peptide) are secreted by the heart in proportion to cardiac transmural pressures. The relationship between plasma levels of these peptides and "cardiac load" has led to their use as biomarkers of cardiac health with diagnostic and prognostic applications in a variety of disorders affecting the cardiovascular system. Elevated NP levels may serve as an early warning sign to help identify patients at a high risk of cardiac events. BNP and its N-terminal fragment (NT-BNP) are especially sensitive indicators for cardiac dysfunction and remodeling (correlate with severity) and play a role in the detection of coronary artery disease. The favorable biological properties of NP have also led to their use as therapeutic agents. Recombinant human ANP (carperitide) and BNP (nesiritide) are useful in the management od acutely decompensated heart failure.